The Impact of Femtosecond Laser on Intraocular Pressure With Cataract Surgery in Healthy Eyes

Abstract

Précis: Femtosecond laser-assisted cataract surgery leads to an increase in intraocular pressure (IOP) during the procedure and subsequent IOP reduction after surgery, with greater magnitude in eyes with higher preoperative IOP. Purpose: To evaluate the effect of femtosecond laser-assisted cataract surgery (FLACS) using the LDVZ8 laser on intraocular pressure (IOP) during and after surgery, and to compare the IOP-lowering effect of FLACS and conventional phacoemulsification cataract surgery (CPCS) Patients and Methods: This prospective cohort study enrolled 395 healthy eyes (395 patients) scheduled for FLACS (n=245) and CPCS (n=150). FLACS was performed using the LDVZ8 laser. During FLACS, IOP was assessed before and immediately after docking. IOP reduction during a six-month postoperative period was evaluated following FLACS and CPCS. Multivariate analyses were performed. Results: Mean IOP increase after docking was 2.3±4.1 mmHg (P<0.0001); maximum increase 17.6 mmHg, peak 38 mmHg. Sixty-one (61) eyes (25.1%) demonstrated an increase of ≥5 mmHg and 10 (3.7%) showed an increase of ≥10 mmHg; pre-docking IOP was associated with an IOP increase of ≥5 mmHg (P-0.029). IOP reduction over six months post-surgery was similar for FLACS and CPCS (P>0.05),-1.33±3.12 mmHg for FLACS (P<0.001) and -1.4±2.87 mmHg for CPCS (P<0.001). Preoperative IOP correlated statistically significantly with IOP reduction in both FLACS (β −0.742, P<0.001) and CPCS (β −0.743, P<0.001). Conclusions: Although the LDVZ8 laser procedure causes an increase in IOP in some healthy eyes, a subsequent decrease in IOP is observed after FLACS. The IOP-lowering effect of FLACS is similar to CPCS, and tends to be more pronounced in eyes with higher preoperative IOP. Eyes with higher preoperative IOP are prone to IOP elevation during FLACS, a critical consideration for glaucoma patients.