Randomized Controlled Trial Comparing 1-Year Outcomes of Low-Energy Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification

Yu-Chi Liu; Melina Setiawan; Jia Ying Chin; Benjamin Wu; Hon Shing Ong; Ecosse Lamoureux; Jodhbir S Mehta

doi:10.3389/fmed.2021.811093

Randomized Controlled Trial Comparing 1-Year Outcomes of Low-Energy Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification

Front Med (Lausanne). 2021 Dec 17:8:811093. doi: 10.3389/fmed.2021.811093. eCollection 2021.

Authors

Yu-Chi Liu^{1

2

3

4}, Melina Setiawan¹, Jia Ying Chin¹, Benjamin Wu¹, Hon Shing Ong^{1

2

3

4}, Ecosse Lamoureux^{5

6}, Jodhbir S Mehta^{1

2

3

4}

Affiliations

¹ Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.
² Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.
³ Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore.
⁴ Ophthalmology and Visual Sciences Academic Clinical Program, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore.
⁵ Population Health Group, Singapore Eye Research Institute, Singapore, Singapore.
⁶ Health Services and System Research Department, Population Health Research, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore.

Abstract

Purpose: To compare 1-year clinical outcomes, phacoemulsification energy, aqueous profiles, and patient-reported outcomes of low-energy femtosecond laser-assisted cataract surgery (FLACS) vs. conventional phacoemulsification. Methods: The study is a randomized controlled trial (RCT) with paired-eye design. Eighty-five patients were randomized to receive FLACS (Ziemer LDV Z8) in one eye and conventional phacoemulsification in the fellow eye. Clinical data including phacoemulsification energy parameters (cumulative dissipated energy, phacoemulsification power, and phacoemulsification time), uncorrected and corrected distance visual acuities (UCDVA and BCDVA), manifest refraction spherical equivalent (MRSE), central corneal thickness (CCT), endothelial cell count (ECC), anterior chamber flare, and post-operative complications were obtained for 1 year. Aqueous humor was collected for the analysis of prostaglandin (PGE)₂, cytokines and chemokines concentrations. Patients' reported-outcomes on surgical experiences were evaluated using an in-house questionnaire. Results: Compared to conventional phacoemulsification, the low-energy assisted FLACS group had significantly less ECC reduction at 3 months (1.5 ± 0.3% vs. 7.0 ± 2.4%; P < 0.01) and 1 year (8.2 ± 2.8% vs. 11.2 ± 3.6%; P = 0.03). There were no significant differences in the phacoemulsification energy parameters, UCDVA, BCDVA, MRSE, CCT, occurrence of post-operative complications between the 2 groups throughout post-operative 1 year. Patients' subjective surgical experiences, including the surgical duration and perceived inconvenience, were comparable between the 2 groups. FLACS resulted in significantly higher aqueous PGE₂ (P < 0.01), interleukin (IL)-6 (P = 0.03), IL-8 (P = 0.03), and interferon (IFN)-γ (P = 0.04) concentrations and greater anterior chamber flare at 1 day (P = 0.02). Conclusions: Our RCT presented 1-year longitudinal clinical and laboratory data. The long-term ECC result was more favorable in low-energy FLACS. The rest of the intraoperative and post-operative outcomes, as well as patient-reported outcomes, were comparable between these two procedures.

Keywords: aqueous profiles; clinical outcomes; conventional phacoemulsification; low-energy femtosecond laser-assisted cataract surgery; patient-reported outcomes; randomized controlled trial.