Comparison of Perioperative Parameters in One-handed Rotational Phacoemulsification Versus Conventional Phacoemulsification and Femtosecond Laser-assisted Cataract Surgery

Overview

Journal Int J Ophthalmol

Specialty Ophthalmology

Date 2021 Dec 20

PMID 34926201

Authors

Samuele Gigliola

Giancarlo Sborgia

Alfredo Niro

Carmela Palmisano

Pasquale Puzo

Gianluigi Giuliani

Luigi Sborgia

Dario Sisto

Valentina Pastore

Claudio Furino

Rossella Donghia

Alessandra Sborgia

Francesco Boscia

Giovanni Alessio

Affiliations

Soon will be listed here.

Abstract

Aim: To compare perioperative parameters of one-handed rotational phacoemulsification technique (one-handed phaco-roll) with each of other two techniques, "Divide et Conquer" and femtosecond laser-assisted cataract surgery (FLACS).

Methods: In this retrospective and comparative cohort study, eyes with uncomplicated cataract (nuclear density grade 2 to 3) treated routinely with one-handed phaco-roll (=23; Group 1) or "Divide et Conquer" (=23; Group 2) or FLACS (=23; Group 3) were enrolled. Intraoperative parameters including effective phaco-time (EPt), ultrasound time (USt), aspiration time, surgical time, phacoemulsification (phaco)-power, balanced salt solution (BSS) use, cumulative dissipated energy (CDE) were recorded and compared. Clinical outcomes including best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), endothelial cell loss (ECL), central corneal thickness (CCT) and central macular thickness (CMT), were assessed and compared pre-operatively and at 1mo after surgery.

Results: Aspiration and surgical time, and BSS used were lower in Group 1 (<0.01) than other groups. EPt, phaco-power and CDE were lower in Group 1 (<0.05) than Group 2 but not significantly different from Group 3. In Group 1, USt was lower (<0.05) than Group 2 but higher (<0.05) than Group 3. BCVA improved in all groups without significant difference between Group 1 and the other ones. No significant differences regarding all post-operative morphologic outcomes (ECD, ECL, CCT, CMT) were reported. No clinical complications occurred.

Conclusion: One-handed phaco-roll seems to be less time-consuming than "Divide et Conquer" and FLACS and less energy-consuming than "Divide et Conquer". Furthermore, one-handed phaco-roll seems to have an equal safety profile compared to the other two techniques.

References

. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol. 1985; 103(12):1796-806. View

Day A, Burr J, Bennett K, Hunter R, Bunce C, Dore C . Femtosecond laser-assisted cataract surgery compared with phacoemulsification: the FACT non-inferiority RCT. Health Technol Assess. 2021; 25(6):1-68. PMC: 7883211. DOI: 10.3310/hta25060. View

Park J, Yum H, Kim M, Harrison A, Kim E . Comparison of phaco-chop, divide-and-conquer, and stop-and-chop phaco techniques in microincision coaxial cataract surgery. J Cataract Refract Surg. 2013; 39(10):1463-9. DOI: 10.1016/j.jcrs.2013.04.033. View

Chen X, Xiao W, Ye S, Chen W, Liu Y . Efficacy and safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract: a meta-analysis of randomized controlled trials. Sci Rep. 2015; 5:13123. PMC: 4542520. DOI: 10.1038/srep13123. View

Cheung S, Cho P . Endothelial cells analysis with the TOPCON specular microscope SP-2000P and IMAGEnet system. Curr Eye Res. 2000; 21(4):788-98. DOI: 10.1076/ceyr.21.4.788.5548. View

Chlasta-Twardzik E, Nowinska A, Wylegala E . Comparison of the selected parameters of the anterior segment of the eye between femtosecond laser-assisted cataract surgery, microincision cataract surgery, and conventional phacoemulsification: A case-control study. Medicine (Baltimore). 2019; 98(52):e18340. PMC: 6946246. DOI: 10.1097/MD.0000000000018340. View

Assaf A, Aly M, Zaki R, Shaaban Y, Aziz B . Femtosecond Laser-Assisted Cataract Surgery in Soft and Hard Nuclear Cataracts: A Comparison of Effective Phacoemulsification Time. Clin Ophthalmol. 2021; 15:1095-1100. PMC: 7956887. DOI: 10.2147/OPTH.S300145. View

Filkorn T, Kovacs I, Takacs A, Horvath E, Knorz M, Nagy Z . Comparison of IOL power calculation and refractive outcome after laser refractive cataract surgery with a femtosecond laser versus conventional phacoemulsification. J Refract Surg. 2012; 28(8):540-4. DOI: 10.3928/1081597X-20120703-04. View

Mahdy M, Eid M, Mohammed M, Hafez A, Bhatia J . Relationship between endothelial cell loss and microcoaxial phacoemulsification parameters in noncomplicated cataract surgery. Clin Ophthalmol. 2012; 6:503-10. PMC: 3334211. DOI: 10.2147/OPTH.S29865. View

10.

Conrad-Hengerer I, Hengerer F, Schultz T, Dick H . Effect of femtosecond laser fragmentation on effective phacoemulsification time in cataract surgery. J Refract Surg. 2012; 28(12):879-83. DOI: 10.3928/1081597X-20121116-02. View

11.

Storr-Paulsen A, Norregaard J, Ahmed S, Storr-Paulsen T, Pedersen T . Endothelial cell damage after cataract surgery: divide-and-conquer versus phaco-chop technique. J Cataract Refract Surg. 2008; 34(6):996-1000. DOI: 10.1016/j.jcrs.2008.02.013. View

12.

Takacs A, Kovacs I, Mihaltz K, Filkorn T, Knorz M, Nagy Z . Central corneal volume and endothelial cell count following femtosecond laser-assisted refractive cataract surgery compared to conventional phacoemulsification. J Refract Surg. 2012; 28(6):387-91. DOI: 10.3928/1081597X-20120508-02. View

13.

Conrad-Hengerer I, Hengerer F, Al Juburi M, Schultz T, Dick H . Femtosecond laser-induced macular changes and anterior segment inflammation in cataract surgery. J Refract Surg. 2014; 30(4):222-6. DOI: 10.3928/1081597X-20140321-01. View

14.

Kawahara A, Kurosaka D, Yoshida A . Comparison of surgically induced astigmatism between one-handed and two-handed cataract surgery techniques. Clin Ophthalmol. 2013; 7:1967-72. PMC: 3794842. DOI: 10.2147/opth.s52415. View

15.

Van Nuffel S, Claeys M, Claeys M . Cystoid Macular Edema Following Cataract Surgery with Low-Energy Femtosecond Laser versus Conventional Phacoemulsification. Clin Ophthalmol. 2020; 14:2873-2878. PMC: 7524180. DOI: 10.2147/OPTH.S261565. View

16.

Nagy Z, Takacs A, Filkorn T, Sarayba M . Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery. J Refract Surg. 2009; 25(12):1053-60. DOI: 10.3928/1081597X-20091117-04. View

17.

Ang R, Quinto M, Cruz E, Rivera M, Martinez G . Comparison of clinical outcomes between femtosecond laser-assisted versus conventional phacoemulsification. Eye Vis (Lond). 2018; 5:8. PMC: 5911953. DOI: 10.1186/s40662-018-0102-5. View

18.

Pajic B, Cvejic Z, Pajic-Eggspuehler B . Cataract Surgery Performed by High Frequency LDV Z8 Femtosecond Laser: Safety, Efficacy, and Its Physical Properties. Sensors (Basel). 2017; 17(6). PMC: 5492121. DOI: 10.3390/s17061429. View

19.

Guell J, Vazquez M, Lucena J, Velasco F, Manero F . Phaco rolling technique. J Cataract Refract Surg. 2004; 30(10):2043-5. DOI: 10.1016/j.jcrs.2004.05.005. View

20.

KELMAN C . Phaco-emulsification and aspiration. A new technique of cataract removal. A preliminary report. Am J Ophthalmol. 1967; 64(1):23-35. View