Clinical Outcomes in the First Two Years of Femtosecond Laser-Assisted Cataract Surgery

PURPOSE: To analyze outcomes of femtosecond laser cataract surgery cases in the first 2 years in an ophthalmic institution. DESIGN: Nonrandomized treatment comparison with matched, historical controls. METHODS: Outcomes and intraoperative events of all laser cataract surgeries (5.0- to 5.5-mm-diameter laser capsulotomies and nuclear fragmentation) at the Singapore National Eye Centre (May 2012-December 2013) were prospectively audited. The 6-weeks-postoperative unaided visual acuities (UAVA), mean absolute error (MAE), mean square error (MSE), and manifest refraction spherical equivalent (MRSE) results of surgeons with > 50 laser cases were compared with controls, a random sample of manual cases with similar age, axial length, and preoperative cylinders. Statistical analysis was performed with SPSS (P < .05). RESULTS: A total of 1105 eyes (803 patients) underwent laser cataract surgery by 18 surgeons. The majority were female (56.9%) and Chinese (90.9%) with mean age 66.1 +/- 11.0 years. Intraoperative complications were subconjunctival hemorrhage (290,26.2%), anterior capsule tear (9 eyes, 0.81%), posterior capsule rupture (3 eyes, 0.27%), suction loss (5 eyes, 0.45%), iris hemorrhage (1 eye, 0.09%), and endothelial incision (1 eye, 0.09%). There was no dropped nucleus. Visual outcomes of 794 laser surgeries were compared to 420 controls. The %UAVA 20/25 or better was higher in laser cases (68.6% vs 56.3%; P < .0001) but MAE (0.30 +/- 0.25 diopter [D] vs 0.33 +/- 0.25; P = .062) and MSE (0.16 +/- 0.27 D vs 0.17 +/- 0.28 D; P = .065) were not significant. MRSE comparison was significant (target piano, preoperative cylinder < 1.5 D -0.08 +/- 0.36 D vs -0.13 +/- 0.40 D; P = .034). CONCLUSIONS: Femtosecond laser cataract surgery has a low complication rate. Cases compared to controls had statistically better %UAVA <= 20/25 and MRSE, although MAE was not significant. (C) 2015 by Elsevier Inc. All rights reserved.