Corneal endothelial cell count following femtosecond laser-assisted cataract surgery versus conventional phacoemulsification

Abstract

Purpose The aim of this work was to study and compare the safety and efficacy of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification cataract extraction on the corneal endothelial cell count. Design The study design was a prospective, comparative one. Participants and methods Fifty eyes underwent femtosecond laser-assisted cataract surgery and 50 eyes underwent conventional phacoemulsification between March 2014 and December 2014 at Ain-Shams University Hospitals and Magrabi Eye Institutes. In each group, 50 eyes (50 patients) underwent cataract surgery using either femtosecond laser-assisted (Alcon LenSx Laser) (the femtolaser group) or conventional phacoemulsification (the phaco group). Femtosecond laser-assisted cataract surgery involved anterior capsulotomy and lens fragmentation based on optical coherence tomography-guided treatment mapping. Conventional procedure involved manual continuous curvilinear capsulorrhexis. Both procedures were completed by means of standard phacoemulsification and insertion of an intraocular lens. Endothelial cell count was measured with a NIDEK Specular Microscopy (CEM-530) preoperatively, and at 1 day, 1 week, and 1 month postoperatively. Main outcome measures included effective phacoemulsification time, intraoperative complication rates, and corneal endothelial cell count. Results Effective phacoemulsification time was reduced by 38% in the femtolaser group (P < 0.0001). All cases treated with the femtosecond laser achieved complete capsulotomy. There was one posterior capsule rupture in the femto group and two in the phaco group (0.5%; not significant). There was no statistically significant difference as regards intraoperative complications between the two groups. Postoperatively, there was a significant decrease in central corneal endothelial cell count in both groups compared with preoperative values. The endothelial cell count was significantly higher in the femtolaser group at 1 day, 1 week, and 1 month follow-up. Conclusion Femtosecond laser-assisted cataract surgery appears to be as safe as conventional cataract surgery, with lower effective phacoemulsification time and hence less corneal endothelial cell loss.

Keywords

• cataract surgery
• endothelial count
• femtosecond
• phacoemulsification