Femtosecond laser-assisted cataract surgery with bimanual technique: learning curve for an experienced cataract surgeon

• Published in: International ophthalmology 2019-01, Vol.39 (1), p.1-9
• Main Authors: Cavallini, Gian Maria, Verdina, Tommaso, De Maria, Michele, Fornasari, Elisa, Volpini, Elisa, Campi, Luca
• Format: Article
• Language: English
• Subjects: Acuity; Astigmatism; Cataracts; Complications; Cornea; Endothelial cells; Eye (anatomy); Eye lens; Eye surgery; Lasers; Learning; Medical personnel; Medicine; Medicine & Public Health; Ophthalmology; Original Paper; Quality; Sclerosis; Surgeons; Surgery; Visual acuity
• ISSN: 0165-5701; 1573-2630
• DOI: 10.1007/s10792-017-0776-z

Purpose To describe the intraoperative complications and the learning curve of microincision cataract surgery assisted by femtosecond laser (FLACS) with bimanual technique performed by an experienced surgeon. Methods It is a prospective, observational, comparative case series. A total of 120 eyes which underwent bimanual FLACS by the same experienced surgeon during his first experience were included in the study; we considered the first 60 cases as Group A and the second 60 cases as Group B. In both groups, only nuclear sclerosis of grade 2 or 3 was included; an intraocular lens was implanted through a 1.4-mm incision. Best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), central corneal thickness and endothelial cell loss (ECL) were evaluated before and at 1 and 3 months after surgery. Intraoperative parameters, and intra- and post-operative complications were recorded. Results In Group A, we had femtosecond laser-related minor complications in 11 cases (18.3%) and post-operative complications in 2 cases (3.3%); in Group B, we recorded 2 cases (3.3%) of femtosecond laser-related minor complications with no post-operative complications. Mean effective phaco time (EPT) was 5.32 ± 3.68 s in Group A and 4.34 ± 2.39 s in Group B with a significant difference ( p  = 0.046). We recorded a significant mean BCVA improvement at 3 months in both groups ( p   0.05). Finally, we found significant ECL in both groups with a significant difference between the two groups ( p  = 0.042). Conclusions FLACS with bimanual technique and low-energy LDV Z8 is associated with a necessary initial learning curve. After the first adjustments in the surgical technique, this technology seems to be safe and effective with rapid visual recovery and it helps surgeons to standardize the crucial steps of cataract surgery.