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Using the free floating anterior capsule for corneal endothelium protection during femtosecond laser-assisted cataract surgery

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Session Details

Session Title: Evolution in FLACS & Phaco Technology

Session Date/Time: Sunday 23/09/2018 | 08:00-09:45

Paper Time: 08:18

Venue: Room A3, Podium 2

First Author: : N.Piravej GERMANY

Co Author(s): :    R. Neuhann   T. Neuhann                 

Abstract Details


To quantify changes in endothelial cell counts and corneal thickness measurements in patients having standard femtosecond laser-assisted cataract surgery (FLACS) compared to femtosecond laser-assisted cataract surgery with the free floating anterior capsule adhered to the corneal endothelium as biological shield.


Augenklinik am Marienplatz, Munich, Germany


This is a prospective randomized intra-individual cohort study. Both eyes of the patients needed cataract surgery. The first eye received FLACS with the free floating anterior capsular adhered to the corneal endothelium for maximum protection of the endothelial cells. The second eye of the same patient acted as control group having regular FLACS. The patients underwent slit-lamp examination, non contact endothelial cell count and Pentacam® pre- and postoperatively. The follow up examination was at 1 day, 5 days and 3 weeks after the surgery. Effective phaco power was also documented for each eye. All surgeries were performed by one surgeon.


A total of 30 patients with an average age of 71.3 years were divided into two groups (study group and control group). The mean endothelial cell loss was -0.18%± 0.5% (SD) at the 1st postoperative control and 0.11% ± 0.62% at the third postoperative control in the study group and -0.12% ± 4.45% and -0.03 ± 1.09%, respectively in the control group. The pachymetry of the study group showed postoperative improvement from 533.25 µm to 547.17 µm and the control group from 523.36 µm to 535.8 µm, respectively.


The shield protection with the free floating anterior capsule created by laser capsulotomy did not induce any endothelial damage. This new kind of endothelial protection during cataract surgery might be beneficial especially in eyes with low preoperative endothelial cell values (e.g. cornea guttata) because healthy endothelium did not show any cell damage. This is an unique advantage of Femtolaser-assisted cataract surgery with free floating capsulotomy.

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