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Comparison of four versions of nanosecond laser photofragmentation cataract surgery handpieces and phacoemulsification: duration, fluidics, and energy dispersion correlated with short-term outcomes

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First Author: G.Sauder GERMANY

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To compare four nanosecond laser photofragmentation handpiece versions and phacoemulsification in terms of duration, fluidics, and energy dispersion, and to correlate these parameters with short-term visual acuity, corneal thickness, and endothelial cell loss.


Charlottenklinik für Augenheilkunde, Stuttgart, Germany


One-hundred and fifty patients, matched for age and cataract grade (LOCS grade III), were enrolled in this randomized ethics committee approved study after they provided informed written consent. They were randomly assigned to receive either phacoemulsification (control group) with nanosecond laser photofragmentation cataract surgery (30 patients per group). Intraoperative parameters were the time required for the phase of cataract removal, fluidics, and energy dispersion. Postoperative parameters were the time required to achieve best uncorrected visual acuity, corneal thickness modifications, and endothelial cell loss.


The fourth-generation handpiece, with the major improvement of a 20% larger opening for energy dispersion and aspiration, provided the greatest degree of aspiration and cataract fragment holding capacity among all the photofragmentation hand-pieces. The newer the handpiece, the better the improvement in fluidics and reduced time. But the reduction in energy required for cataract removal was only moderate. The improvement in time and fluidics approached but did not reach those required for phacoemulsification. The energy required for photofragmentation was always significantly lower than that required for phacoemulsification. Also, the time required to obtain best uncorrected visual acuity was significantly lower and the endothelial cell sparing was significantly better.


With the evolution of the nanosecond laser photofragmentation technique, it is now comparable to phacoemulsification in terms of time and fluidics, but requires significantly lower energy thus providing a significant improvement in endothelial cell sparing and time required to achieve best uncorrected visual acuity. The different versions of the hand-pieces should not be considered as excluding older versions, which may be used in less dense cataracts or to suit individual surgeons’ preferences and techniques.

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