J Korean Ophthalmol Soc.  2017 May;58(5):539-545. 10.3341/jkos.2017.58.5.539.

Possible Risk Factors Affecting Successful Femtosecond Laser-assisted Cataract Surgery

• Yang H
• Han SY
• Lee KH

• KMID: 2378624
• DOI: http://doi.org/10.3341/jkos.2017.58.5.539

Abstract

PURPOSE
To determine the risk factors of intraoperative complications in femtosecond laser-assisted cataract surgery.
METHODS
This study included 598 eyes of 337 patients who underwent femtosecond laser-assisted cataract surgery (FLACS) between July, 2012 and January, 2017. All eyes had corneal incisions, anterior capsulotomy, nuclear fragmentation, and limbal relaxing incisions (if required). Intraoperative complications were analyzed by watching videos, and the related factors of each complication were retrospectively reviewed alongside the medical records.
RESULTS
The mean age of the patients was 62.1 ± 11.9 years. Among the study group, 18 eyes required manual creation of corneal incisions; because the corneal incisions could not be made due to corneal central opacity, corneal peripheral degeneration, ptreygium, conjunctival chalasis, or idiopathic. The anterior capsulotomy was incomplete in 43 cases and manual capsulorrhexis was required for completion. These cases were associated with various conditions, including hypermature cataract, anterior polar or subcapsular cataract, corneal central opacity, pupillary abnormality, lens subluxation, poor pupil dilation, and idiopathic. Overall, 22 eyes had difficulties with nuclear fragmentation, with either mature cataract, lens subluxation, corneal central opacity, anterior polar or subcapsular cataract, or pupillary abnormality. Using the Laser SoftFitâ„¢ patient interface decreased the incidences of incomplete corneal incision (from 3.56% to 2.24%, p = 0.367), anterior capsulotomy (from 9.31% to 4.03%, p < 0.05), and nuclear fragmentation (from 5.20% to 1.34%, p < 0.05). The incidences of complications in the experienced group was statistically lower compared with the novice group (p < 0.05 for all comparisons).
CONCLUSIONS
The femtosecond laser platform was effective and safe for cataract surgery. However, in the presence of related factors, use of this platform might need to be re-assessed and should be considered for intraoperative complications. Additionally, with the Laser SoftFitâ„¢ patient interface and improved surgeon experience, better intraoperative results can be expected for FLACS surgery.

Keyword

Anterior capsulotomy; Corneal incision; Femtosecond cataract surgery; Nuclear fragmentation; Related factors

MeSH Terms

Capsulorhexis
Cataract*
Corneal Opacity
Humans
Incidence
Intraoperative Complications
Lens Subluxation
Medical Records
Pupil
Retrospective Studies
Risk Factors*

Figure

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  Figure 1 Advantages of SoftFit™ patient interface. In contrast to solid direct patient interface, the design of the new hydrogel SoftFit™ interface (white arrow) has an extended suction ring skirt that allows the natural curvature of the cornea and delivers a gentle, secure fit with minimal corneal distortion. With the soft contact lens in place, the intraocular pressure remains much lower during the procedure and corneal compression and corneal folds are minimized.

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  Figure 2 Rates of intraoperative complications before and after SoftFit™ interface. Comparison (%) of incomplete corneal incision, incomplete capsulotomy, incomplete nucleus fragmentation between femtosecond laser refractive cataract surgery with a direct contact interface (Pre-SoftFit™) and SoftFit™ interface (Post-SoftFit™). *p-value<0.05 between groups using Pearson Chi-square test.

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  Figure 3 Rates of intraoperative complications between novice group and experienced group. Comparison (%) of incomplete corneal incision, incomplete capsulotomy, incomplete nucleus fragmentation between novice group (200 cases) and experienced group (398 cases). *p-value < 0.05 between groups using Pearson Chi-square test.

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