This retrospective study found that biaxial cortex removal time in femtosecond laser-assisted cataract surgery was comparable to that in standard phacoemulsification.
Discussions regarding femtosecond laser-assisted cataract surgery have raised concerns about the difficulty of cortical removal. Surgeons have had to adapt their cortical removal technique after femtosecond capsulotomy to account for the lack of anterior cortical tags to grasp and strip the cortex from the capsule. Many surgeons feel that the adapted technique of cortical removal is, at least at first, more difficult and may result in an increased risk of complications and reduce the efficiency of surgery.
The authors of this study sought to address these concerns through a retrospective comparison of video files of 400 femtosecond-assisted cataract surgeries and 400 standard cataract surgeries.
Average cortex removal time was 30 seconds in the standard group and 27 seconds in the femtosecond group (P < 0.005). No anterior or posterior capsular tears occurred in either group.
This study demonstrates that for an experienced surgeon, cortical removal after femtosecond laser surgery is more or less equal in safety and efficiency to standard phaco. The study is well-sized with 400 patients in each group, and the preoperative characteristics of the two groups were not significantly different. Although the study is not randomized, prospective or blinded, it’s unlikely that bias would have a significant effect on the findings given the nature of the study.
Still, it remains unclear if these findings can be generalized to other femtosecond lasers. Differences in imaging, laser parameters and air versus liquid interface may play a role in any of the endpoints investigated here. There also does not seem to be a significant advantage to cortical removal after femtosecond laser-assisted cataract surgery. The time required and the safety level are essentially equal to traditional methods. On the other hand, the markedly lower amount of phaco time and energy required after femtosecond treatment with the Catalys laser is notable.
Questions to consider:
Have surgeons using different femtosecond lasers found similar results?
Does this study provide convincing evidence that femtosecond laser merits the extra cost, or does it just demonstrate that surgery with the laser is only “just as good” as with traditional phaco?
For those still considering whether or not to purchase a femtosecond cataract laser, do these results significantly sway your thinking?
What important questions in this area (cortical removal after femtosecond laser-assisted cataract surgery) still need to be answered?