Surgical efficiency in femtosecond laser cataract surgery compared with phacoemulsification cataract surgery: a case-control study

Alexander C Day, Phillip R Smith, Hongying Lilian Tang, Francesco Aiello, Badrul Hussain, Vincenzo Maurino, John Marshall, George M Saleh, Alexander C Day, Phillip R Smith, Hongying Lilian Tang, Francesco Aiello, Badrul Hussain, Vincenzo Maurino, John Marshall, George M Saleh

Abstract

Objectives: To investigate differences in surgical time, the distance the surgical instrument travelled and number of movements required to complete manual phacoemulsification cataract surgery versus femtosecond laser cataract surgery.

Design: Non-randomised comparative case series.

Setting: Single surgery site, Moorfields Eye Hospital, UK.

Participants: 40 cataract surgeries of 40 patients.

Interventions: Laser-assisted and manual phacoemulsification cataract surgery. Laser-assisted surgery cases were performed using the AMO Catalys platform.

Primary and secondary outcome measures: Computer vision tracking software PhacoTracking were applied to the recordings to establish the distance the instrument travelled, total number of movements (the number of times an instrument stops and starts moving) and time taken for surgery steps including phacoemulsification, irrigation-aspiration (IA) and overall surgery time. The time taken for laser docking and delivery was not included in the analyses.

Results: Data on 19 laser-assisted and 19 manual phacoemulsification surgeries were analysed (two cases were excluded due to insufficient video-recording quality). There were no differences in the number of instrument moves, the distance the instrument travelled or time taken to complete the phacoemulsification stage. However for IA, the number of instrument moves (manual: mean 20 (SD 15) vs laser: mean 38 (SD 22), P=0.008) and time taken (manual: mean 75 s (SD 24) vs laser: mean 108 s (SD 36), P=0.003) were significantly greater for laser cases. For laser versus manual cases overall, there was no difference in number of moves or the distance the instrument travelled, but laser cases took longer (mean 88 s, P=0.049).

Conclusions: Laser cataract surgery cases took longer to complete without accounting for the time taken to complete the laser procedure itself. This appears to be in part due to IA requiring more instrument manoeuvres and taking longer to complete. Data from a large randomised series would better elucidate this relationship.

Keywords: cataract and refractive surgery; corneal and external diseases; ophthalmology.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Measured (A) instrument number of moves, (B) path length and (C) time taken for phacoemulsification stage of manual phacoemulsification compared with femtosecond laser-assisted cases.
Figure 2
Figure 2
Measured (A) instrument number of moves, (B) path length and (C) time taken for irrigation–aspiration stage of manual phacoemulsification compared with femtosecond laser-assisted cases.
Figure 3
Figure 3
Measured (A) instrument number of moves, (B) path length and (C) time taken overall for manual phacoemulsification compared with femtosecond laser-assisted cases.

References

    1. Bourne RR, Stevens GA, White RA, et al. . Causes of vision loss worldwide, 1990-2010: a systematic analysis. Lancet Glob Health 2013;1:e339–49. 10.1016/S2214-109X(13)70113-X
    1. Palanker DV, Blumenkranz MS, Andersen D, et al. . Femtosecond laser-assisted cataract surgery with integrated optical coherence tomography. Sci Transl Med 2010;2:58ra85 10.1126/scitranslmed.3001305
    1. Day AC, Gartry DS, Maurino V, et al. . Efficacy of anterior capsulotomy creation in femtosecond laser-assisted cataract surgery. J Cataract Refract Surg 2014;40:2031–4. 10.1016/j.jcrs.2014.07.027
    1. Dooley IJ, O’Brien PD. Subjective difficulty of each stage of phacoemulsification cataract surgery performed by basic surgical trainees. J Cataract Refract Surg 2006;32:604–8. 10.1016/j.jcrs.2006.01.045
    1. Day AC, Gore DM, Bunce C, et al. . Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery. Cochrane Database Syst Rev 2016;7:CD010735 10.1002/14651858.CD010735.pub2
    1. Titiyal JS, Kaur M, Singh A, et al. . Comparative evaluation of femtosecond laser-assisted cataract surgery and conventional phacoemulsification in white cataract. Clin Ophthalmol 2016;10:1357–64. 10.2147/OPTH.S108243
    1. Steinert RF. Femto future: sizzle or steak? Ophthalmology 2012;119:889–90. 10.1016/j.ophtha.2012.02.036
    1. Roberts TV, Lawless M, Bali SJ, et al. . Surgical outcomes and safety of femtosecond laser cataract surgery: a prospective study of 1500 consecutive cases. Ophthalmology 2013;120:227–33. 10.1016/j.ophtha.2012.10.026
    1. Conrad-Hengerer I, Schultz T, Jones JJ, et al. . Cortex removal after laser cataract surgery and standard phacoemulsification: a critical analysis of 800 consecutive cases. J Refract Surg 2014;30:516–20. 10.3928/1081597X-20140624-01
    1. Smith P, Tang L, Balntas V, et al. . “PhacoTracking”: an evolving paradigm in ophthalmic surgical training. JAMA Ophthalmol 2013;131:659–61. 10.1001/jamaophthalmol.2013.28
    1. Saleh GM, Lindfield D, Sim D, et al. . Kinematic analysis of surgical dexterity in intraocular surgery. Arch Ophthalmol 2009;127:758–62. 10.1001/archophthalmol.2009.137
    1. Din N, Smith P, Emeriewen K, et al. . Man versus machine: software training for surgeons-an objective evaluation of human and computer-based training tools for cataract surgical performance. J Ophthalmol 2016;2016:1–7. 10.1155/2016/3548039
    1. Bay H, Ess A, Tuytelaars T, et al. . Speeded-Up Robust Features (SURF). Computer Vision and Image Understanding 2008;110:346–59. 10.1016/j.cviu.2007.09.014
    1. Conrad-Hengerer I, Al Juburi M, Schultz T, et al. . Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser-assisted cataract surgery: three-month follow-up. J Cataract Refract Surg 2013;39:1307–13. 10.1016/j.jcrs.2013.05.033
    1. Schargus M, Suckert N, Schultz T, et al. . Femtosecond laser-assisted cataract surgery without OVD: a prospective intraindividual comparison. J Refract Surg 2015;31:146–52. 10.3928/1081597X-20150220-01
    1. Conrad-Hengerer I, Hengerer FH, Al Juburi M, et al. . Femtosecond laser-induced macular changes and anterior segment inflammation in cataract surgery. J Refract Surg 2014;30:222–6. 10.3928/1081597X-20140321-01
    1. Yu AY, Ni LY, Wang QM, et al. . Preliminary clinical investigation of cataract surgery with a noncontact femtosecond laser system. Lasers Surg Med 2015;47:698–703. 10.1002/lsm.22405
    1. Hou JH, Prickett AL, Cortina MS, et al. . Safety of femtosecond laser-assisted cataract surgery performed by surgeons in training. J Refract Surg 2015;31:69–70. 10.3928/1081597X-20141218-07

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться