Randomised Controlled Trial comparing Femtosecond Laser-Assisted and Conventional Phacoemulsification on Dense Cataracts.

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To compare the benefit of femtosecond laser-assisted cataract surgery (FLACS) versus phacoemulsification (PE) and two fragmentation patterns in managing dense cataracts.Randomized controlled trial METHODS: Patients with nuclear opacity (NO) grade > 5 (LOCS III) were recruited at the Singapore National Eye Centre. Patients unsuitable for FLACS, corneal endothelial cell count (ECC) < 1500 cells/mm2 or cataracts with additional complexities were excluded from the study. Eyes were randomized to PE, 600μm grid (FLACSg) or 16 segment fragmentation (FLACS16) in 2:1:1 ratio. The Victus™ (Bausch + Lomb, Munich, Germany) laser platform and in-situ phaco chop technique was used. Data on patient demographics, preoperative and 1 month post-operative best corrected visual acuity (BCVA), ECC, effective phacoemulsification time (EPT) and perioperative complications was collected. Outcome measures were the loss of ECC at 1 month and EPT.93 patients were randomized into 48 PE, 22 FLACSg and 23 FLACS16. Majority were Chinese (87, 93.5%). Mean age was 74.3 ±8.8 years. Cataracts were mostly graded NO5-6 (49, 61.3%). EPT among treatment arms was not different (p=0. 097, One way ANOVA) but was significantly higher for NO > 6 than NO < 6 (P<0.001, General linear model). ECC loss was significantly less in FLACSg than PE (P=0.018, Bonferroni correction). Mean 1 month postoperative LogMAR BCVA (0.23±0.20) was significantly better than preoperative BCVA (1.02±0.85) (P<0.001, paired T test), but not different between PE and FLACS.FLACSg but not FLACS16 significantly lowered the mean ECC loss during phacoemulsification in dense cataracts.

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Authors: Soon-Phaik Chee, Younian Yang, Melissa Hy Wong