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. 2021 May 18;14(5):684-692.
doi: 10.18240/ijo.2021.05.07. eCollection 2021.

Comparing corneal outcome between femtosecond laser-assisted cataract surgery and conventional phaco surgery in Fuchs' endothelial dystrophy patients: a randomized pilot study with 6mo follow up

Therese Krarup  1 , Kathrine Rose  1 , Aurore Marie-Laurence Akpé Mensah  1 , Morten la Cour  1 , Lars Morten Holm  1
Affiliations

Comparing corneal outcome between femtosecond laser-assisted cataract surgery and conventional phaco surgery in Fuchs' endothelial dystrophy patients: a randomized pilot study with 6mo follow up

Therese Krarup et al. Int J Ophthalmol. .

Abstract

Aim: To compare the corneal outcome in Fuchs' endothelial dystrophy (FED) patients between femtosecond laser-assisted cataract surgery (FLACS) and conventional phaco surgery (CPS).

Methods: This was a randomized controlled study comparing one eye surgery by FLACS and the contralateral eye operated by CPS (stop and chop technique) in FED patients. Central corneal thickness, corneal light backscatter, corneal densitometry, and central corneal endothelial cell count and hexagonality (noncontact endothelial cell microscope), and corrected distance visual acuity (CDVA) were assessed preoperatively and at day 1, 40, and 180 postoperatively.

Results: Totally 31 patients (16 women) were included. At day 40 postoperatively, the mean endothelial cell loss (ECL) was 23.67% by FLACS and 17.30% by CPS (P=0.53). At day 180 postoperatively, ECL was 25.58% in FLACS and 21.32% in CPS (P=0.69). Densitometry data in all layers and all annuli from anterior layer to posterior layer in annuli 0-2, 2-6, 6-10 and 10-12, total densitometry with all layers and all annuli was performed. A significant difference was found in 6-10 (posterior layer) at day 1 with -1.42 grayscale units (GSU; 95%CI: -2.66 to -0.19, P=0.02). In 10-12 (anterior layer, central layer and all layers) at day 40 were significant different with 7.7 (95%CI: 1.89 to 13.50, P=0.009), 3.97 (95%CI: 0.23 to 7.71, P=0.03), 4.73 GSU (95%CI: 0.71 to 8.75, P=0.02), respectively. In the remaining parameters we found no difference between the two groups (P>0.05). Three CPS eyes suffered from corneal decompensation.

Conclusion: There is no significant difference in corneal outcome between FLACS and CPS. Endothelial cell density and pentacam corneal outcome may be inadequate as outcome parameters in FED patients.

Keywords: Fuchs' endothelial dystrophy; cataract surgery; central corneal thickness; corneal endothelial cell loss; femtosecond-assisted cataract surgery; pentacam.

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Figures

Figure 1
Figure 1. Corneal thickness and central to periphery ratio 4 and 6 mm outcome at days 1, 40, and 180 in FLACS, CPS and data pooled
Pooled: FLACS and CPS combined. Error bars: Standard error of the mean. aP<0.05; bP<0.01; cP<0.001. FLACS: Femto-assisted laser cataract surgery; CPS: Conventional phacoemulsification surgery; CCT: Central corneal thickness; CPRT: Corneal periphery ratio thickness.
Figure 2
Figure 2. Corneal light backscatter at 0-2 mm annulus all layers and 0-12 mm annulus all layers
There was no difference between CPS and FLACS. When pooling data there was a significant difference between preoperative and day 1 and day 40. The difference became insignificant at day 180. Error bars: standard error of the mean. Significance level: aP<0.05; bP<0.01; cP<0.001. FLACS: Femto-assisted laser cataract surgery; CPS: Conventional phacoemulsification surgery.
Figure 3
Figure 3. ECD in 20 patients
There was no difference between CPS and FLACS. When pooling data there was a significant difference between preoperative status and day 40 and day 180. Error bars: Standard error of the mean. aP<0.05; bP<0.01; cP<0.001. FLACS: Femto-assisted laser cataract surgery; CPS: Conventional phacoemulsification surgery; ECD: Endothelial cell density.
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