Less pupil variation in Femtosecond Laser-Assisted Cataract Surgery than Phacoemulsification

A retrospective review of registered surgical data from patients that undergone uncomplicated cataract surgery in a single centre, with randomly assigned femtosecond laser–assisted cataract surgery (FLACS) to one eye and conventional phacoemulsification (CP) to the other, was performed. The recorded pupil images were evaluated at pre and post laser treatment (after suction release) and at several surgical time points for both techniques (FLACS and CP). Pupil areas were calculated and compared in the same eye undergone FLACS (pre vs post laser treatment), between eyes (CP vs FLACS) in the same patient and between groups. Subgroups were built regarding age and ocular comorbidity.

• This study involved a total of 164 eyes of 82 patients. No statistical differences regarding the total duration of surgery (p=0.805) between FLACS and CP.

• Pupil measurements between pre and post laser treatment in the FLACS group showed no statistically significant differences (p=0.107).

• The mean change in pupil area from the beginning until the end of surgery (total variation) was 6.59±2.08 mm2 in the FLACS group and 6.67±2.13 mm2 in the CP group, associated to less narrowing of pupil area with FLACS, although not statistically significant (p=0.080).

• Comorbidity group analysis revealed less, but not significant, pupil narrowing with the FLACS technique (p=0.071).

• No statistically significant differences between FLACS and CP concerning age subgroups were registered.

In conclusion, this intraindividual study provides extended evidence of lack of laser-induced myosis with low-energy FLACS. Furthermore, regarding pupil status, low-energy femtosecond laser-assisted energy seems to compare favorably with conventional phacoemulsification in the presence of certain ocular comorbidities. Although not statistically significant, this difference arises an interesting discussion and, also in line with contemporary literature, it recommends revision of some established, global opinions on FLACS. Further studies on low-energy femtosecond laser-assisted cataract surgery, involving higher samples and rigorous variable control, are in demand for this matter.

Source: Salgado et al; Clinical Ophthalmology 2023:17

https://doi.org/10.2147/OPTH.S399788