ESCRS - PO012 - Comparing Early And Delayed Phacoemulsification In Femtosecond Laser Assisted Cataract Surgery

Comparing Early And Delayed Phacoemulsification In Femtosecond Laser Assisted Cataract Surgery

Published 2022 - 40th Congress of the ESCRS

Reference: PO012 | Type: Case report | DOI: 10.82333/2pzr-bj76

Authors: Francesca Kahale* 1 , Kevin Makhoul 2 , Wassef Chanbour 2 , Jason Brenner 2 , Samir Melki 1

1Cornea,Mass Eye and Ear,Boston,United States;Boston Vision,Boston,United States, 2Boston Vision,Boston,United States

Grade 4 cataract removal requires a lot of energy, threatening the corneal endothelium. Femtosecond Laser Assisted Cataract Surgery (FLACS) reduces the amount of ultrasound used and potentially endothelial cell loss. Currently, the standard of care when using Femtosecond Laser anterior capsulotomy and lens fragmentation is performing capsulotomy and phacoemulsification on the same day. We hypothesize that delayed phacoemulsification may soften the cataract leading to reduction in intra-op ultrasound and corneal endothelium preservation in grade 4 nuclear cataracts.

81-year-old patient presented with a 4+ nuclear sclerosing cataract OU. BCVA was 20/200 OD and 20/400 OS. Preoperative endothelial cell count was comparable, 1840 c/mm2 OD vs 1900 c/mm2 OS.

The right eye received standard same day FLACS while the left eye had femtosecond treatment (Capsulotomy+ Octant nucleus fragmentation) followed by phacoemulsification 2 days later. The Eye with delayed phacoemulsification was treated prophylactically with steroid preoperatively

Phacoemulsification and IOL implantation surgical time was 11 minutes and 40 seconds OD, and 7 minutes and 10 seconds OS. Average ultrasonic longitudinal power was 15.9% OD compared to 13.8% OS. Irrigation/Aspiration time OD was 3 minutes 40 seconds and 2 minutes and 8 seconds OS. Uncorrected visual acuity at 1 months and 6 months was 20/25 OU. Delaying phacoemulsification after capsulotomy did not induce IOP spikes or inflammation in the anterior chamber. Endothelial cell count was comparable at 6 months post-op, 1350 OD and 1425 OS. The Surgeon reported easier removal of epi-nucleus and cortical material while the fragmented nucleus was reported to have similar density.

Delayed phacoemulsification had a lower total surgical duration and irrigation/aspiration time compared to same day FLACS. No difference was noted in phacoemulsification time or endothelial cell count. Despite the promising results, larger comparative studies are needed ​to prove the safety and the benefit of spacing out the procedures.