Laser lens fragmentation of hard nuclear cataracts

1. Harvey Uy¹
2. Keith Edwards²
3. Dieza Aninao¹
4. Pik Sha Chan¹
5. Jose Francisco III¹
6. Karen Arriola¹

¹Asian Eye Institute, Makati City, Philippines
²LensAR Inc, Orlando, Florida, USA

Purpose: To investigate the effectiveness of femtosecond laser lens fragmentation (FLLF) in eyes with higher grade cataracts.

Methods: This prospective clinical study involved 77 eyes with Grade 3 and Grade 4 nuclear opacities. Fifty-four eyes received FLLF (Grade 3= 27 eyes; Grade 4= 27 eyes) prior to start of cataract surgery while 23 contralateral eyes, comprising the control group (Grade 3= 16 eyes; Grade 4= 7 eyes), underwent conventional phacoemulsification surgery. The main outcome measure was the total ultrasound energy used for lens removal as measured by cumulative dissipated energy (CDE).

Results: For Grade 3 cataracts, the mean (SD) CDE was 8.8 (9.3) for the FLLF group versus 14.8 (12.6) for the control group (p=0.04). For Grade 4 cataracts, the mean (SD) CDE for the FLLF group was 24.0 (18.8) versus 41.2 (24.7) for the control group (p=0.0496). The mean amount of CDE reduction was -40.5% and -41.6% for Grades 3 and 4 cataracts, respectively.

Conclusions: In this series of eyes with dense cataracts, FLLF reduced the amount of ultrasound energy required to remove the nucleus by over 40%. FLLF may improve the efficiency and safety of cataract surgery in these more challenging cases.