A Comparative Cohort Study of Visual Outcomes in Femtosecond Laser-Assisted versus Phacoemulsification Cataract Surgery

详细信息    查看全文

• 作者：Shaun Y.P. Ewe ; MBBS¹ ; Robin G. Abell ; MBBS¹ ; Carmen L. Oakley ; MBBS¹ ; Chris H.L. Lim ; MBBS¹ ; Penelope L. Allen ; PhD¹ ; Zachary E. McPherson ; BMedSci² ; Anupam Rao ; MBBS² ; Peter E.J. Davies ; FRANZCO² ; Brendan J. Vote ; FRANZCO¹ ; ^{eye.vote@me.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：BCVA ; best-corrected visual acuity ; CME ; cystoid macular edema ; D ; diopter ; IOL ; intraocular lens ; LCS ; laser-assisted cataract surgery ; NS ; not significant ; PCS ; phacoemulsification cataract surgery ; SD ; standard definition
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：123
• 期：1
• 页码：178-182
• 全文大小：179 K

文摘

To evaluate visual outcomes after femtosecond laser-assisted cataract surgery (LCS) with phacoemulsification cataract surgery (PCS).

Design

Prospective, multicenter, comparative case series.

Participants

Consecutive patients undergoing femtosecond LCS or PCS with intraocular lens insertion.

Methods

A total of 1876 eyes of 1238 patients (422 male and 772 female) who underwent cataract surgery between January 2012 and June 2014 were included in the study: 1017 eyes from center A and 859 eyes from center B. Cases underwent clinico-socioeconomic selection. Patients with absolute LCS contraindications were assigned to PCS; otherwise, all patients were offered LCS and elected on the basis of their decision to pay (the out-of-pocket cost for LCS). Demographic and postoperative data were collected to determine differences between groups.

Main Outcome Measures

Six-month postoperative visual and refractive outcomes. Masked subjective refractions were performed 2 to 6 months postoperatively.

Results

There were 988 eyes in the LCS group and 888 eyes in the PCS group. Baseline best-corrected visual acuity (BCVA) was better in LCS compared with PCS (20/44.0 vs. 20/51.5; P < 0.0003). Preoperative surgical refractive aim differed significantly between groups (LCS −0.28 vs. PCS −0.23; P < 0.0001). More patients who received LCS had Toric lenses implanted compared with PCS (47.4% vs. 34.8%; P < 0.0001). Postoperative BCVA was better after LCS (20/24.5 vs. 20/26.4; P = 0.0003) with a greater proportion of LCS cases achieving BCVA >20/30 (LCS 89.7% vs. PCS 84.2%; P = 0.0006) and 20/40 (LCS 96.6% vs. PCS 93.9%; P = 0.0077). However, PCS cases had more letters gained compared with LCS cases (13.5 vs. 12.5 letters; P = 0.0088), reflecting baseline BCVA differences. Mean absolute error was higher in LCS compared with PCS (0.41 diopters [D] vs. 0.35 D; P < 0.0011). The percentage of eyes within 0.5 D of error from preoperative aim refraction was higher in the PCS group (LCS 72.2% vs. PCS 82.6%; P < 0.0001).

Conclusions

Femtosecond LCS did not demonstrate clinically meaningful improvements in visual outcomes over conventional PCS.