Comparison Of Corneal Endothelial Cell Loss In Femtosecond Laser-Assisted Cataract Surgery And Conventional Phacoemulsification

Published 2022 - 40th Congress of the ESCRS

Reference: PP10.14 | Type: ESCRS 2022 - Posters | DOI: 10.82333/3fjv-ty66

Authors: Altantsetseg Altansukh ¹ , Sheng- Chuan Ma* ² , Adiyabazar Doyodmaa ³ , Ning Hung ⁴ , Eugene Yu-Chuan Kang ⁴ , David Hui-Kang Ma ⁴

¹Department of Ophthalmology ,Health Center of Bayangol District,Ulaanbaatar,Mongolia, ²Department of Medicine,Catholic University of the Sacred Heart Rome, Roma ,Italy, ³Department of Ophthalmology,Gegeen Melmii Hospital,Ulaanbaatar,Mongolia, ⁴Department of Ophthalmology,Chang-Gung Memorial Hospital,Taoyuang,Taiwan, Province of China

Purpose

In the past few years, the benefit of femtosecond laser-assisted cataract surgery in reducing corneal endothelial damage has been extensively studied. However, almost all of the studies were focused on changes in the central cornea. In reality, the corneal endothelial density varies in different region, with endothelial density generally higher in the periphery. During surgery, the area near the entrance wound may potentially suffer more damage. Also, it remains unknown whether creation of entrance wound by laser may cause additional endothelial damage. Therefore, this study aims to compare changes in corneal endothelial cells in different part of the cornea following femtosecond laser-assisted or conventional phacoemulsification( phaco)

Setting

This is a single center, retrospective study.

Methods

Patients who received femtosecond laser-assisted (Alcon LenSx System) or conventional phaco (Alcon Infiniti System) from 2018 and 2021 were recruited. Before and 6 M after OP, patients were examined by a NIDEK CEM-530 specular microscope, which allowed simultaneous measurement of endothelial density at different parts of the cornea. The electronic medical records were reviewed, and following data were retrieved: 1. Total phaco energy. 2. Total phaco time. 3. Pre-OP and post-OP 6 M corneal endothelial density at central cornea (position 1), nearest (position 2), and farthest from entrance wound (position 3). Changes expressed as percentage of the original density were compared. Independent two-sample t-test was used for data comparison.

Results

62 eyes from 57 patients receiving LenSx, and 73 eyes from 69 patients receiving phaco were enrolled. The mean age was 61.9±13.8 and 64.2±12.0 y/o respectively (p=0.358). The total phaco energy and time was significantly lower in the LenSx group (16.8±12.9 vs 23.8±11.8 CDE, p=0.001; 51.1±20.8 vs 74.6±38.3 sec, p=0.001). Pre-operatively, the endothelial density in the LenSx and phaco group at position 1 was similar (2603±404 vs 2577±384). Cell density was also similar at position 2 (2581±493 vs 2661±399) and at position 3 (2648±476 vs 2700±510). At post-OP 6 M, changes in endothelial density at position 1 was -0.13% vs -2.7% (p=0.098), -13.6% vs -14.7% at position 2 (p=0.684), +1.74% vs -2.36% at position 3 (p=0.036).

Conclusions

Compared with conventional phaco, LenSx required significantly less phaco energy and time to complete the surgery, and caused less endothelial cell loss. Of note, despite the fact that endothelial cell loss rate in both the LenSx and phaco group at position 2 was much higher than position 1 and 3, less endothelial loss was found in the LenSx group, suggesting that compared with entrance wound formation by knife, wound formation by the laser did not cause further damage to corneal endothelium.