All-laser versus femto-phaco

Study finds nanosecond laser surgery spares corneal endothelium long-term

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Peter A Mattei MD, PhD
Replacing torsional phacoemulsification with a nanosecond laser photofragmentation device in femtosecond laser-assisted cataract surgery may reduce long-term corneal endothelial cell loss, suggests a study presented at the 36th Congress of the ESCRS in Vienna. Two years after surgery, 17 eyes in 17 patients undergoing all-laser cataract surgery showed less endothelial cell loss than 18 patients receiving femto-phacoemulsification cataract surgery, said Peter A Mattei MD, PhD. This study showed that reduced endothelial cell loss noted early after surgery in the all-laser group compared with the femto-phaco group persisted for two years. The effect also may be related to increased corneal thickness noted in the femto-phaco group in the early post-surgery period. Conducted at Prof Mastropasqua’s Ophthalmology Department at the University “G. d’Annunzio” in Chieti-Pescara, Italy, the prospective, chronologically randomised trial compared 21 consecutive cataract patients receiving femtosecond laser treatment with a LensAR platform followed by torsional phacoemulsification with an Alcon Constellation system,with 21 consecutive patients treated with the LensAR followed by photofragmentation using the Centus Nano-Laser System (A.R.C. Laser). The nanosecond laser fragments the nucleus using 4-5 nanosecond pulses of 1,064nm near-infrared wavelength with a pulse frequency up to 10Hz. Fragments are aspirated in much the same way as with a coaxial phaco handpiece. Patients ranged in age from 65 to 75 with cataracts up to LOCS grade 3, endothelial cell density greater than 1,200/mm2 and no other ocular pathologies. Data were collected on all patients out to 730 days after surgery, with four femto-nanolaser and three femto-phaco patients lost to follow-up. Early results showed greater corneal thickness in the femto-phaco group in both the corneal centre and near the handpiece tunnel, though thickness returned to baseline at 60 days, Dr Mattei reported. There were no statistically significant differences in visual acuity or corneal thickness in the centre or near the tunnel at 60 days, he added. However, endothelial cell losses were significantly greater in the femto-phaco group at 90 days (p=0.004) and 730 days (p<0.001), Dr Mattei said. Prof Mastropasqua’s group concluded: “The long-term results showed that the initial lower corneal tissue trauma and lower endothelial cell loss in the femto-nanolaser group compared with the femto-phaco group yielded a long-term sparing of corneal endothelial cell in all-laser cataract surgery.” Peter A Mattei: pamattei@unich.it
Tags: endothelial cell loss, femto laser, phacoemulsification