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    Femtosecond laser surgery still raising bar for cataract surgery outcomes

    Surgeons, technologies striving to meet patient demands; key to safety, effectiveness, efficiency



    The safety outcomes with femtosecond laser cataract surgery show evidence of a learning curve, and are comparable or superior to standard phacoemulsification.

    Dr. Packer cited a study (Roberts et al. Ophthalmology 2013;120:227-33) that showed the importance of mastering the learning curve associated with femtosecond laser cataract surgery.

    In this study, investigators evaluated the outcomes and safety of femtosecond laser cataract surgery in 1,500 patients in one practice who had been divided into two groups based on surgeon experience (group 1 included the first 200 patients treated with femtosecond laser cataract surgery and group 2 included 1,300 patients who underwent the same surgery performed by the same surgeons).

    After evaluating complication rates between the two groups, it was clear that surgeons improved with experience.

    The respective complication rates between groups 1 and 2 are as follows: anterior capsular tears, 4% and 0.31%; posterior capsular tears, 3.5% and 0.31%; posterior lens dislocation, 2% and 0%; number of docking attempts/case, 1.5 and 1.06; incidence of postlaser pupillary constriction, 9.6% and 1.23%; and anterior capsular tags, 10.5% and1.61% (p < 0.001 for all comparisons).

    When compared with traditional phacoemulsification, the complication rates associated with femtosecond laser cataract surgery are markedly lower, as demonstrated by Chen and colleagues (Int J Ophthalmol. 2015;8:201-203).

    When investigators evaluated five surgeons who performed traditional phacoemulsification and laser-assisted cataract surgery, they found that overall complications rates were 5.8% and 1.8%, respectively.

    However, another study found the integrity of the anterior capsulotomy may be compromised with femtosecond laser cataract surgery and that a learning curve may be responsible for part of the increased complication rate (femtosecond laser, 1.87% in 15 of 804 cases versus traditional phacoemulsification, 0.12% in 1 of 822 cases; p = 0.0002), Dr. Packer noted.

    Safety (cont.)

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