Refractive laser-assisted cataract surgery vs. standard manual surgery: Comparing efficacy and safety in 2844 eyes in the early transition period

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Authors: Harrish Nithianandan, Vibeeshan Jegatheeswaran, Logan Germain, Tobi Ajayi, Steve A. Arshinoff, Eric Tam, Sohel Somani
Author Disclosure Block: H. Nithianandan: None. V. Jegatheeswaran: None. L. Germain: None. T. Ajayi: None. S.A. Arshinoff: Employment/honoraria/consulting fees; Name of Commercial Company(s); Alcon, ZEISS, Rayner, I-MED Pharma, Inc., and ArcticDx Inc.. E. Tam: None. S. Somani: None.

Abstract Body:

Purpose: The evidence supporting the use of either femtosecond refractive laser assisted cataract surgery (ReLACS) versus manual cataract surgery (MCS) is conflicting. This study adds to this body of evidence by reporting on the largest Canadian series of patients undergoing either modality of cataract extraction in the early transition period.

Study Design: This was an IRB-approved retrospective consecutive case series.

Methods: Patients who underwent either ReLACS or MCS at an outpatient cataract surgery suite in Toronto, Canada were included. Patients were excluded from the analysis if the procedure was not completed or if an accompanying procedure was performed. All data was collected via electronic medical records. Preoperative variables of interest included patient gender, age, mean keratometry, axial length, anterior chamber depth and intraocular pressure (IOP). Eyes were numerically graded on their surgical degree of difficulty (DoD) based upon pre-defined characteristics of complex cataracts. Intraoperative outcomes were surgical time, effective phacoemulsification time (EPT) and complications. One-week postoperative refractive deviation from target was also collected.

Results: This study included 1568 ReLACS (55% Female) eyes and 1276 MCS (55% Female) eyes. The mean±SD differences in preoperative age [ReLACS: 68.6±9.5 vs. MCS: 70.7±9.7 years] and surgical time [ReLACS: 6.6±2.9 vs. MCS: 6.0±2.6 minutes] were statistically significant between the groups (p<0.001). Mean preoperative keratometry [ReLACS: 43.8±1.7 vs. MCS: 43.8±2.8], axial length [ReLACS: 23.4±3.9 vs. MCS: 23.6±2.1 mm], anterior chamber depth [ReLACS: 3.1±0.6 vs. MCS: 3.1±0.9 mm], and IOP [ReLACS: 15.0±4.6 vs. MCS: 14.8±3.5 mmHg] did not differ between the groups (p>0.05). Mean surgical DoD [ReLACS: 0.36±0.6 vs. MCS: 0.28±0.5] was significantly greater in the ReLACS eyes (p<0.001). Rates of posterior capsular rupture [ReLACS: 0.77% vs. MCS: 0.24%] were similar (p>0.05). The overall postoperative refractive deviation from target [ReLACS: 0.7±2.9 vs. MCS: 0.7±3.4] did not differ between the groups (p>0.05). Two-Factor ANOVA revealed significantly less EPT in ReLACS eyes when the DoD>0 [ReLACS: 33.5±28.6 vs. MCS: 39.9±24.5 seconds, p=0.004). Refractive deviation from target was less in the ReLACS eyes when the DoD>0 [ReLACS: 0.61±0.7 vs. MCS: 0.73±0.9] and when the DoD>1 [ReLACS: 0.65±0.6 vs. MCS: 0.95±1.3], however these differences were not statistically significant (p>0.05).

Conclusions: Despite ReLACS treating slightly more difficult eyes in our series, overall safety and efficacy were comparable between both groups. In difficult eyes, ReLACS is superior in reducing EPT. Trends indicated that ReLACS may be beneficial for refractive accuracy in more difficult eyes.