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Khirurgii

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Year 2018 Vol. 26 No 6

REVIEWS

V.V. PRISTUPA, N.K. KARALKOVA, E.A. KHADASEVICH

FEMTOSECOND LASER IN CATARACT SURGERY: TECHNOLOGICAL REDUNDANCY OR A NEW LEVEL OF POSSIBILITIES

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

This review presents modern data about the pros and cons of femtosecond lasers usage in cataract surgery. International scientific and medical databases “PubMed” and “Cochrane library” were used. The study showed that femtolaser assistance provides a new level of accuracy in different stages of the operation, which guaranties their standardization, unification and predictability. Using laser assistance in all patients, it is possible to get anterior-capsular holes of a given diameter within ±0.25 mm; if capsulorhexis is performed manually, such level of accuracy will be obtained only in 10% of the operated eyes. At the same time, it was found that despite the increase in the accuracy of the stages performed by femtosecond lasers, the differences in postoperative refractive indicators and visual acuity in patients who underwent phacoemulsification of cataracts with laser assistance are not higher than in the application of the standard technique. In addition, due to high cost of the equipment and lack of a significant effect in post-operative visual acuity, the widespread introduction of femtosecond lasers in cataract surgery is still doubtful. Despite the absent of consensus of experts about the clear advantages of laser assistance, this technique should be developed, for so that it provides opportunity to determine the influence of different stages on the final result of the operation and determine the direction of their further improvement and standardization of the stages creates the prerequisites for the use of ophthalmic robots.

Keywords: femtosecond laser, cataract surgery, phacoemulsification, lens nucleus, capsulorhexis, QALY
p. 745-757 of the original issue
References
  1. Bourne RRA, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Resnikoff S, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. Lancet Glob Health. 2017 Sep;5(9):e888-e897. doi: 10.1016/S2214-109X(17)30293-0
  2. Lee CM, Afshari NA. The global state of cataract blindness. Curr Opin Ophthalmol. 2017 Jan;28(1):98-103. doi: 10.1097/ICU.0000000000000340
  3. Blindness: Vision 2020 - control of major blinding diseases and disorders. The global initiative for the elimination of avoidable blindness [Electronic resource]. Fact Sheet. ¹214. [cited 2018 Ìàð 20]. Available from: http://www.who.int/mediacentre/factsheets/fs214/en/
  4. Kessel L, Andresen J, Erngaard D, Flesner P, Tendal B, Hjortdal J. Indication for cataract surgery. Do we have evidence of who will benefit from surgery? A systematic review and meta-analysis. Acta Ophthalmol. 2016 Feb; 94(1):10-20. doi: 10.1111/aos.12758
  5. Nagy Z, McAlinden C. Femtosecond laser cataract surgery. Eye Vis.(London). 2015;2:11. doi: 10.1186/s40662-015-0021-7
  6. Hatch KM, Talamo JH. Laser-assisted cataract surgery: benefits and barriers. Curr Opin Ophthalmol. 2014 Jan;25(1):54-61. doi: 10.1097/ICU.0000000000000013
  7. Abell RG, Darian-Smith E, Kan JB, Allen PL, Ewe SY, Vote BJ. Femtosecond laser-assisted cataract surgery versus standard phacoemulsification cataract surgery: outcomes and safety in more than 4000 cases at a single center. J Cataract Refract Surg. 2015 Jan;41(1):47-52. doi: 10.1016/j.jcrs.2014.06.025
  8. Nagy Z. New technology update: femtosecond laser in cataract surgery. Clin Ophthalmol. 2014 Jun;8:1157-67. doi: 10.2147/OPTH.S36040
  9. Kelman CD. Phaco-emulsification and aspiration. A report of 500 consecutive cases. Am J Ophthalmol. 1973 May;75(5):764-68. doi: 10.1016/0002-9394(73)90878-7
  10. Callou TP, Garcia R, Mukai A, Giacomin NT, de Souza RG, Bechara SJ. Advances in femtosecond laser technology. Clin Ophthalmol. 2016 Apr;19;10:697-703. doi: 10.2147/OPTH.S99741
  11. Miháltz K, Knorz MC, Alió JL, Takács AI, Kránitz K, Kovács I, Nagy ZZ. Internal aberrations and optical quality after femtosecond laser anterior capsulotomy in cataract surgery. J Refract Surg. 2011 Oct;27(10):711-16. doi: 10.3928/1081597X-20110913-01
  12. Vasquez-Perez A, Simpson A, Nanavaty M. Femtosecond laser-assisted cataract surgery in a public teaching hospital setting. BMC Ophthalmol. 2018;18:26. Published online 2018 Feb 2. doi: 10.1186/s12886-018-0693-6
  13. Wolffsohn J., Buckhurst P. Objective analysis of toric intraocular lens rotation and centration. J Cataract Refract Surg. 2010 May;36(5):778-82. doi: 10.1016/j.jcrs.2009.12.027
  14. Krasnov MM. Laser-phakopuncture in the treatment of soft cataracts. Br J Ophthalmol. 1975 Feb;59(2):96-98. https://bjo.bmj.com/content/bjophthalmol/59/2/96.full.pdf
  15. Nagy Z, Takács A, Filkorn T, Sarayba M. Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery. J Refract Surg. 2009 Dec;25(12):1053-60. doi: 10.3928/1081597X-20091117-04
  16. McAlinden C, Moore JE. Retreatment of residual refractive errors with flap lift laser in situ keratomileusis. Eur J Ophthalmol. 2011 Jan-Feb;21(1):5-11. doi: 10.5301/EJO.2010.391
  17. Bartlett JD, Miller KM. The economics of femtosecond laser-assisted cataract surgery. Curr Opin Ophthalmol. 2016 Jan;27(1):76-81. doi: 10.1097/ICU.0000000000000219.
  18. Chung SH, Mazur E. Surgical applications of femtosecond lasers. J Biophotonics. 2009 Oct;2(10):557-72. doi: 10.1002/jbio.200910053.
  19. Binder PS. Femtosecond applications for anterior segment surgery. Eye Contact Lens. 2010 Sep;36(5):282-85. doi: 10.1097/ICL.0b013e3181ee2d11
  20. Hjortdal J, Nielsen E, Vestergaard A, Søndergaard A. Inverse cutting of posterior lamellar corneal grafts by a femtosecond laser. Open Ophthalmol J. 2012;6:19-22. doi: 10.2174/1874364101206010019
  21. Levitz L, Reich J, Roberts TV, Lawless M. Incidence of cystoid macular edema: femtosecond laser-assisted cataract surgery versus manual cataract surgery. J Cataract Refract Surg. 2015 Mar;41(3):683-86. doi: 10.1016/j.jcrs.2014.11.039
  22. Nagy ZZ, Takacs AI, Filkorn T, Kránitz K, Gyenes A, Juhász é, Sándor GL, Kovacs I, Juhász T, Slade S. Complications of femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2014 Jan;40(1):20-28. doi: 10.1016/j.jcrs.2013.08.046
  23. Kulikov AN, Kokareva EV, Dzilikhov AA. Effective lens position. A review. Oftal'mokhirurgiia. 2018;(1):92-97. doi: 10.25276/0235-4160-2018-1-92-97 (in Russ.)
  24. Kránitz K, Takács A, Miháltz K, Kovács I, Knorz MC, Nagy ZZ. Femtosecond laser capsulotomy and manual continuous curvilinear capsulorrhexis parameters and their effects on intraocular lens centration. J Refract Surg. 2011 Aug;27(8):558-63. doi: 10.3928/1081597X-20110623-03
  25. Mayer WJ, Klaproth OK, Hengerer FH, Kohnen T. Impact of crystalline lens opacification on effective phacoemulsification time in femtosecond laser-assisted cataract surgery. Am J Ophthalmol. 2014 Feb;157(2):426-32.e1. doi: 10.1016/j.ajo.2013.09.017
  26. Cao H, Zhang L, Li L, Lo S. Risk factors for acute endophthalmitis following cataract surgery: a systematic review and meta-analysis. PLoS One. 2013 Aug 26;8(8):e71731. doi: 10.1371/journal.pone.0071731. eCollection 2013.
  27. Bang JW, Lee JH, Kim JH, Lee DH. Structural analysis of different incision sizes and stromal hydration in cataract surgery using anterior segment optical coherence tomography. Korean J Ophthalmol. 2015 Feb;29(1):23-30. doi: 10.3341/kjo.2015.29.1.23
  28. Kankariya VP, Diakonis VF, Goldberg JL, Kymionis GD, Yoo SH. Femtosecond laser-assisted astigmatic keratotomy for postoperative trabeculectomy-induced corneal astigmatism. J Refract Surg. 2014 Jul;30(7):502-4. doi: 10.3928/1081597X-20140527-01
  29. Abell RG, Kerr NM, Howie AR, Mustaffa Kamal MA, Allen PL, Vote BJ. Effect of femtosecond laser-assisted cataract surgery on the corneal endothelium. J Cataract Refract Surg. 2014 Nov;40(11):1777-83. doi: 10.1016/j.jcrs.2014.05.031
  30. Lawless M, Levitz L, Hodge C. Reviewing the visual benefits of femtosecond laser-assisted cataract surgery: Can we improve our outcomes? Indian J Ophthalmol. 2017 Dec;65(12):1314-22. doi: 10.4103/ijo.IJO_736_17
  31. Popovic M, Campos-Möller X, Schlenker MB, Ahmed IIK. Efficacy and safety of femtosecond laser-assisted cataract surgery compared with manual cataract surgery: a meta-analysis of 14567 eyes. Ophthalmology. 2016 Oct;123(10):2113-26. doi: 10.1016/j.ophtha.2016.07.005
  32. Chang DF. Does femtosecond laser-assisted cataract surgery improve corneal endothelial safety? The debate and conundrum. J Cataract Refract Surg. 2017 Apr;43(4):440-442. doi: 10.1016/j.jcrs.2017.04.019
  33. Day AC, Burr JM, Bunce C, Doré CJ, Sylvestre Y, Wormald RP, Round J, McCudden V, Rubin G, Wilkins MR. Randomised, single-masked non-inferiority trial of femtosecond laser-assisted versus manual phacoemulsification cataract surgery for adults with visually significant cataract: the FACT trial protocol. BMJ Open. 2015 Nov 27;5(11):e010381. doi: 10.1136/bmjopen-2015-010381
  34. Abell RG, Vote BJ. Cost-effectiveness of femtosecond laser-assisted cataract surgery versus phacoemulsification cataract surgery. Ophthalmology. 2014 Jan;121(1):10-16. doi: 10.1016/j.ophtha.2013.07.056
  35. Onukwugha E, McRae J, Kravetz A, Varga S, Khairnar R, Mullins CD. Cost-of-Illness Studies: An Updated Review of Current Methods. Pharmacoeconomics. 2016 Jan;34(1):43-58. doi: 10.1007/s40273-015-0325-4
  36. Ewe SY, Abell RG, Oakley CL, Lim CH, Allen PL, McPherson ZE, Rao A, Davies PE, Vote BJ. A comparative cohort study of visual outcomes in femtosecond laser-assisted versus phacoemulsification cataract surgery. Ophthalmology. 2016 Jan;123(1):178-82. doi: 10.1016/j.ophtha.2015.09.026
  37. Conrad-Hengerer I, Al Sheikh M, Hengerer FH, Schultz T, Dick HB. Comparison of visual recovery and refractive stability between femtosecond laser-assisted cataract surgery and standard phacoemulsification: six-month follow-up. J Cataract Refract Surg. 2015 Jul;41(7):1356-64. doi: 10.1016/j.jcrs.2014.10.044
  38. Day AC, Gore DM, Bunce C, Evans JR. Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery (Review) [Electronic resource]. Cochrane Database of Systematic Reviews. 2016;7. [cited 2018 Sept 4]. Available from: https://researchonline.lshtm.ac.uk/4086875/1/Laser-assisted%20cataract%20surgery_COCHREV.pdf
  39. Ye Z, Li Z, He S. A Meta-analysis comparing postoperative complications and outcomes of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract [Electronic resource]. J Ophthalmol. 2017;2017:3849152 [cited 2018 Nov 233]. Available from: http://www.hindawi.com/journals/joph/2017/3849152
  40. Packer M, Teuma EV, Glasser A, Bott S. Defining the ideal femtosecond laser capsulotomy. Br J Ophthalmol. 2015 Aug;99(8):1137-42. doi: 10.1136/bjophthalmol-2014-306065
  41. Toto L, Mastropasqua R, Mattei PA, Agnifili L, Mastropasqua A, Falconio G, Di Nicola M, Mastropasqua L. Postoperative IOL axial movements and refractive changes after femtosecond laser-assisted cataract surgery versus conventional phacoemulsification. J Refract Surg. 2015 Aug;31(8):524-30. doi: 10.3928/1081597X-20150727-02
  42. Panthier C, Costantini F, Rigal-Sastourné JC, Brézin A, Mehanna C, Guedj M, Monnet D. Change of capsulotomy over 1 year in femtosecond laser-assisted cataract surgery and its impact on visual quality. J Refract Surg. 2017 Jan;33(1):44-49. doi: 10.3928/1081597X-20161028-01
  43. Mursch-Edlmayr AS, Bolz M, Luft N, Ring M, Kreutzer T, Ortner C, Rohleder M, Priglinger SG. Intraindividual comparison between femtosecond laser-assisted and conventional cataract surgery. J Cataract Refract Surg. 2017 Feb;43(2):215-22. doi: 10.1016/j.jcrs.2016.11.046
  44. Oltulu R, Erşan I, Şatırtav G, Donbaloglu M, Kerımoğlu H, özkağnıcı A. Intraocular lens explantation or exchange: indications, postoperative interventions, and outcomes. Arq Bras Oftalmol. 2015 May-Jun;78(3):154-57. doi: 10.5935/0004-2749.20150040
  45. Nagy ZZ, Kiss HJ, Takács ÁI, Kránitz K, Czakó C, Filkorn T, Dunai Á, Sándor GL, Kovács I. Results of femtosecond laser-assisted cataract surgery using the new 2.16 software and the SoftFit® Patient Interface. Orv Hetil. 2015 Feb8;156(6):221-25. doi: 10.1556/OH.2015.30089
  46. Takács AI, Kovács I, Miháltz K, Filkorn T, Knorz MC, Nagy ZZ. Central corneal volume and endothelial cell count following femtosecond laser-assisted refractive cataract surgery compared to conventional phacoemulsification. J Refract Surg. 2012 Jun;28(6):387-91. doi: 10.3928/1081597X-20120508-02
  47. Mastropasqua L, Toto L, Mastropasqua A, Vecchiarino L, Mastropasqua R, Pedrotti E, Di Nicola M. Femtosecond laser versus manual clear corneal incision in cataract surgery. J Refract Surg. 2014 Jan;30(1):27-33. doi: 10.3928/1081597X-20131217-03
  48. Conrad-Hengerer I, Hengerer FH, Al Juburi M, Schultz T, Dick HB. Femtosecond laser-induced macular changes and anterior segment inflammation in cataract surgery. J Refract Surg. 2014 Apr;30(4):222-26. doi: 10.3928/1081597X-20140321-01
  49. Ecsedy M, Miháltz K, Kovács I, Takács A, Filkorn T, Nagy ZZ. Effect of femtosecond laser cataract surgery on the macula. J Refract Surg. 2011 Oct;27(10):717-22. doi: 10.3928/1081597X-20110825-01.
Address for correspondence:
210009, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Ophthalmology,
Tel. +375 33 647-65-95,
e-mail: khodasevich2014@yandex.by,
Eugene A. Khadasevich
Information about the authors:
Pristupa Vadim V., PhD, Associate Professor of the Department of Ophthalmology, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0003-3496-7722
Karalkova Natallia K., PhD, Associate Professor, Acting Head of the Department of Ophthalmology, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-6172-6767
Khadasevich Eugene A., 5-Year Medical Student, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-0810-5005
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