Initial experience using a femtosecond laser cataract surgery system at a UK National Health Service cataract surgery day care centre

Abstract

ObjectivesTo describe the initial outcomes following installation of a cataract surgery laser system.SettingNational Health Service cataract surgery day care unit in North London, UK.Participants158 eyes of 150 patients undergoing laser-assisted cataract surgery.InterventionsLaser cataract surgery using the AMO Catalys femtosecond laser platform.Primary and secondary outcome measuresPrimary outcome measure: intraoperative complications including anterior and posterior capsule tears. Secondary outcome measures: docking to the laser platform, successful treatment delivery, postoperative visual acuities.ResultsMean case age was 67.7±10.8 years (range 29–88 years). Docking was successful in 94% (148/158 cases), and in 4% (6/148 cases) of these, the laser delivery was aborted part way during delivery due to patient movement. A total of 32 surgeons, of grades from junior trainee to consultant, performed the surgeries. Median case number per surgeon was 3 (range from 1–20). The anterior capsulotomy was complete in 99.3% of cases, there were no anterior capsule tears (0%). There were 3 cases with posterior capsule rupture requiring anterior vitrectomy, and 1 with zonular dialysis requiring anterior vitrectomy (4/148 eyes, 2.7%). These 4 cases were performed by trainee surgeons, and were either their first laser cataract surgery (2 surgeons) or their first and second laser cataract surgeries (1 surgeon).ConclusionsDespite the learning curve, docking and laser delivery were successfully performed in almost all cases, and surgical complication rates and visual outcomes were similar to those expected based on national data. Complications were predominately confined to trainee surgeons, and with the exception of intraoperative pupil constriction appeared unrelated to the laser-performed steps.

Posterior capsular complication rates with femtosecond laser-assisted cataract surgery: a consecutive comparative cohort and literature review

“…More recently, the use of FLACS by residents has been shown to be well tolerated, albeit possibly less efficient than conventional techniques at the same stage of training. 32 – 34 Our study found a PCC rate of ~0.3% in both manual and laser cohorts, which is comparable to the best found in the current literature. Of importance is that the FLACS cohort represented all patients with minimal exclusions highlighting the potential use as a revised current benchmark target.…”

Femtosecond Laser-Assisted Cataract Surgery Versus Phacoemulsification Cataract Surgery (FACT)

“…There is a possible surgical learning curve effect for FLACS, with all trial surgeons having performed hundreds to thousands of conventional phacoemulsification cataract surgeries compared with a minimum of 10 FLACS cases to meet trial surgeon eligibility. We have previously published data on the learning curve for FLACS and found that complications tended to occur within the first few cases; 31 however, correspondence suggests the learning curve may include the first 100 cases for FLACS. 32 Even if the FLACS learning curve is 100 cases, the complication rate in the FLACS arm is low, and so it is difficult to see how this would materially affect our findings.…”

Learning curve of femtosecond laser-assisted cataract surgery: Experience of surgeons new to femtosecond laser platform

“…Importantly, we did not find too many instances of the capsular tears and pupillary miosis that had been reported previously. [ 14 15 19 20 21 There is a lot of debate regarding the integrity of the capsulotomy created by the femtosecond laser, predominantly initiated by electron microscopic studies showing ragged edges at the edge of the capsulorhexis. [ 22 ] However, this did not translate into complications as we saw visible capsular tags in only six eyes and radial tear occurred in only one eye.…”