Evaluating the different laser fragmentation patterns used in laser cataract surgeries in terms of effective phacoemulsification time and power

Abstract

PurposeTo evaluate the effects of the different fragmentation patterns for the lens nucleus in terms of the effective phacoemulsification time (EPT) and power.SettingShinagawa LASIK Center, Tokyo, Japan.DesignComparison study.MethodsSeventy-one eyes of 71 patients had preoperative lens opacity grading based on the Emery-Little Classification (Grade 1 and Grade 2). Eyes underwent femtosecond laser-assisted cataract surgery (Catalys™ Precision Laser System), for capsulotomy and lens fragmentation. For the lens fragmentation, either the quadrants softened (Quadrant) or the quadrants complete (Complete) pattern was used. The mean EPT and phacoemulsification (phaco) power for each cutting pattern of Grades 1 and 2 cataracts were evaluated.ResultsThe mean EPT was 28.96 seconds in the Quadrant Group and 16.31 seconds in the Complete Group (P=0.006). The mean phaco power was 8.07% in the Quadrant Group and 4.77% in the Complete Group (P=0.0002). Comparing the Quadrant and Complete Groups of Grade 1 cataract showed no significant difference in EPT (P=0.16), but showed a significant difference in phaco power (P=0.033). Comparing the Quadrant and Complete patterns of Grade 2 cataract showed significant differences in both EPT (P=0.012) and phaco power (P=0.003). Using the Complete pattern showed a 44.7% reduction in EPT and a 40.9% reduction in phaco power when compared to the Quadrant Group.ConclusionUsing the smaller fragmentation pattern in femtosecond laser cataract surgery, the phaco time and power were reduced significantly when compared to the procedure with the larger fragmentation pattern.

Comparison of cumulative dispersed energy between conventional phacoemulsification and femtosecond laser-assisted cataract surgery with two different lens fragmentation patterns

“…They found a reduction in CDE in the FLACS group, but this did not translate into a difference in ECL [13]. The total ultrasound power used during the surgery was calculated by the value of CDE, which revealed a significant reduction in power in the FLACS group as compared with that in the CPS group [15]. However, the effect of FLACS on ECL reduction is still controversial.…”

“…Harvey et al reported that extensive fragmentation, such as a pie-cut pattern, appears to lower the EPT and CDE and might potentially reduce surgical complications as compared with the three-plane chop pattern [16]. The grid pattern of lens fragmentation in FLACS was determined to reduce EPT and ultrasound power as compared with the quadrant pattern [15]. However, no study has demonstrated the different patterns of lens fragmentation in FLACS by performing subgroup analysis based on nuclear density grading.…”

“…There are two major lens fragmentation patterns in FLACS: the grid pattern and radial pattern. Tukezban et al studied 71 eyes undergoing FLACS using different grid patterns and concluded that a smaller grid fragmentation is more beneficial with reduced EPT and ultrasound power [15]. Another study focused on FLACS using different lens fragmentation patterns, including three-plane chop and pie-cut pattern fragmentation; the results showed that the three-plane chop pattern had lower EPT, power, and CDE [16].…”

Comparison of ultrasound energy consumption between low-energy femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery in patients with different cataract densities

“…10,11 Other studies have reported a reduction in CDE with FLACS than with CPS, but most studies did not use the latest low-energy femtosecond laser system or reported results from surgeries performed by a single surgeon. 12–14…”

“…10,11 Other studies have reported a reduction in CDE with FLACS than with CPS, but most studies did not use the latest low-energy femtosecond laser system or reported results from surgeries performed by a single surgeon. [12][13][14] Therefore, this study compared the ultrasound energy consumption in low-energy FLACS with that in CPS. Additionally, we collected patient results from surgeries performed by three surgeons and examined nuclear sclerosis degrees to determine the influence of surgeons' experience and cataract severity on the CDE amount used in cataract surgery.…”