• Cataract/Anterior Segment

    Review of: Comparison of Perioperative Parameters in Femtosecond Laser-Assisted Cataract Surgery Using 3 Nuclear Fragmentation Patterns

    Lyu Danni, Shen Z, Zhang L, et al. American Journal of Ophthalmology, May 2020

    This prospective, randomized clinical trial compared the efficacy and safety of 3 fragmentation patterns in eyes undergoing femtosecond laser-assisted cataract surgery (FLACS).

    Study design

    Researchers randomized 894 eyes of 661 patients undergoing FLACS to quadrant, sextant or grid nuclear fragmentation patterns; the laser platform and surgeon remained the same for all cases. The primary purpose of this study was to study the effective phacoemulsification time (EPT), intraoperative complications, visual acuity and intraocular pressure at postoperative day 1 and endothelial cell density (ECD) as well as endothelial cell loss and central corneal thickness (CCT) at postoperative week 1.


    For grade 1 cataracts, the mean EPT was shortest with the grid pattern. For grade 3 cataracts, mean EPT was significantly shorter with the sextant pattern. For grade 4 and 5 cataracts, the quadrant pattern had the shortest EPT. The mean EPT was similar for all 3 fragmentation patterns among grade 2 cataracts.

    There were no significant differences in mean uncorrected distance visual acuity among the 3 patterns. The average IOP elevation was significantly higher among grade 4 and 5 cataracts undergoing grid fragmentation compared with the quadrant or sextant patterns. One week after surgery, ECD significantly decreased while CCT significantly increased, regardless of nuclear grade; no differences were found among the 3 fragmentation patterns.  


    This study had a limited follow-up time, only going up to the postoperative day 1 and week 1. There was also a differing number of patients with dense (grade 3, 4 and 5) cataracts versus softer cataracts among the study groups.

    Clinical significance

    For surgeons using FLACS, these results can help provide guidelines for lens fragmentation techniques based on nuclear cataract density. This can help optimize surgical performance, reduce phacoemulsification times and achieve good postoperative outcomes.