JCRS Highlights selected by Professor Thomas Kohnen

Femtosecond laser-assisted cataract surgery (FLACS) offers several apparent advantages over standard phacoemulsification surgery in cases of Fuch’s endothelial corneal dystrophy, including a shorter phacoemulsification time and less ultrasound energy use, both of which have been shown to reduce endothelial cell loss and postoperative corneal oedema.

Researchers conducted a retrospective study of 207 eyes of 207 patients with mild-to-moderate risk for corneal compensation, comparing outcomes in 64 FLACS cases and 143 conventional phaco cases. Clinically significant corneal decompensation was defined as corneal oedema with CDVA worse than 20/50 lasting more than three months, any case resulting in keratoplasty or both.

Compared with conventional phaco, FLACS did not lower the rate of corneal decompensation in eyes with mild-to-moderate Fuch’s endothelial corneal dystrophy. The proportion of cases progressing to clinically significant decompensation (13%) was similar between groups. Indeed, several outcomes were significantly worse in the FLACS group, including a higher rate of clinically apparent oedema and greater incidence of clinically severe oedema in the early postoperative period.

The researchers suggest that concurrent endothelial keratoplasty with cataract surgery (triple procedure) be considered in eyes with moderate Fuch’s endothelial corneal dystrophy.

Management of patients with coexisting cataracts and glaucoma remains challenging. Surgeons have an increasing number of options when operating on patients with open-angle glaucoma and visually significant cataract. Researchers compared outcomes of phacoemulsification combined with viscocanalostomy, endocyclophotocoagulation (ECP) or ab interno trabulectomy for intraocular pressure (IOP) control and safety in a study of 109 eyes. Forty-six eyes had combined phacoviscocanalostomy, 35 had phaco–ECP, and 28 eyes phaco–ab interno trabulectomy.

With a mean follow-up of 17 months, the phacoviscocanalostomy group had the lowest mean IOP, 13.5 ± 4.7 mm Hg, a 29% decrease. There was no significant difference in the final IOP between phaco–ECP and phaco–ab interno trabulectomy (16.4 ± 3.9 mm Hg, a 20% decrease versus 15.8 ± 4.2 mm Hg, a 15% decrease). The reduction in the number of medications was greater with phacoviscocanalostomy (77%) than with phaco–ECP (40%) and phaco–ab interno trabulectomy (44%). Phacoemulsification–ab interno trabulectomy had the fewest complications. Intraocular pressure spikes were more frequent in the phaco–ECP group than in the other groups.

The investigators suggest a need for prospective randomised controlled studies to compare these procedures, as well as their long-term effects on IOP stability and glaucoma progression.