Changes in endothelial cell density following conventional phacoemulsification and femtosecond laser-assisted cataract surgery in eyes with dense cataracts

Abstract

Purpose: To compare the safety, effectiveness and changes in endothelial cell density following standard phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS) in dense cataracts (LOCS III grade 3.0 NO and above). Setting: Nethradhama Superspeciality Eye Hospital, Bangalore, India Design: Prospective, randomized, comparative study Method: 100 eyes of 100 patients were randomly assigned to either conventional phacoemulsification surgery (CPS) or FLACS (LENSAR Laser System) using pre-defined patterns of nuclear fragmentations. Measured outcomes included intra-operative phaco time, irrigation fluid volume, surgical time and complication rates. Endothelial cell density was evaluated at baseline, 2 weeks and 6 months post-operatively. Results: The CPS group had significantly higher mean total phaco time (TPT, 11.17 ± 6.5 sec vs 8.03 ± 3.77 sec), effective phaco time (EPT, 6.14 ± 3.62 sec vs 4.42 ± 2.07 sec) and total surgical time (8.18 ± 2.36 min vs 7.11 ± 1.55 min) than the FLACS group (p<0.001). Volume of irrigation fluid was comparable between the two groups (CPS, 36.7 ± 12.18 ml, FLACS, 38.64 ± 13.73 ml, (p =0. 45). Mean corneal oedema score and CCT values on POD-1 were significantly higher for the CPS group. At 6 months, % endothelial cell density (ECD) loss was significantly higher in the CPS group (16.08%) versus the FLACS group (12.8%), p <0.001. Three eyes in the CPS group had wound burns of varying severity. Conclusion: FLACS with customized nuclear fragmentation patterns resulted in significantly less intra-operative phaco time, surgical time and endothelial cell loss compared to conventional phacoemulsification when treating dense cataracts.