Femtosecond Laser for Eyes With AMD

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Findings from the first study to explore the effects of conventional and femtosecond laser-assisted cataract surgery (FLACS) in patients with age-related macular degeneration (AMD) found mixed results. On one hand, FLACS proved beneficial to patients with wet AMD. But on the other, the choice of surgery did not affect the long-term postoperative course.¹

Previous studies have suggested that FLACS dissects and liquefies tissue with higher precision, less collateral damage, and a complication rate comparable to conventional cataract surgery. With that in mind, the researchers had hoped that, compared with phacoemulsification, the laser-assisted surgical option might lead to a more beneficial course of postoperative wet AMD. It did not. In long-term follow-up, changes in mac­ular parameters—central macular thickness, central macular volume, and corrected distance visual acuity (CDVA)—were similar between the groups.

What’s more, the need for postoperative anti–vascular endothelial growth factor (VEGF) injections was the same over a mean follow-up of 619 days (2.67 injections with FLACS, vs. 2.71 with conventional surgery), indicating similar progression of AMD no matter which approach was used.

Long- and short-term outcomes. While the long-term postoperative outcomes were similar, in the short term, the laser-treated eyes had less subclinical macular edema. “Originally, we assumed that the increased prostaglandin levels found in FLACS might pose an increased risk to AMD patients,” said study coauthor Lucas M. Bachmann, MD, PhD, at the Uni­versity of Zurich in Switzerland. “That patients after FLACS had a lower macular postoperative thickness than patients undergoing conventional phacoemulsification came as a surprise.”

Limitations. These findings need confirmation, Dr. Bachmann said, not­ing, “The small number of patients in the FLACS group led to imprecise es­timates of the treatment effect.” Only 17 of the 140 study eyes underwent FLACS with the Catalys system (AMO), while the majority (n = 123) had conventional cataract surgery.

Looking ahead. FLACS does hold promise, the study suggests. A subanalysis involving eyes that were evaluated by optical coher­ence tomography within 2 weeks of surgery (n = 33) showed po­tential for FLACS as a treatment option.

While only 4 eyes in this sub­group underwent FLACS, they did have a significantly lower central macular volume.

This short-term effect, in a real-life setting, indicates that patients with high macular vul­nerability, including those with wet AMD, diabetic retinopathy, and retinal vein occlusion might benefit from FLACS, Dr. Bachmann said. “We are only starting to un­derstand the possible benefits of FLACS. We presume that group differences may be even more pronounced in an adequately sized, controlled study.”

—Miriam Karmel

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1 Enz TJ et al. J Cataract Refract Surg. 2018;44(1):23-27.

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Relevant financial disclosures: Dr. Bachmann—None.

For full disclosures and the disclosure key, see below.

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