Eyeworld

EW RESIDENTS 58 January 2019 by Karine Bojikian, MD, PhD, Shu Feng, MD, Joanne Ho, MD, and Elysse Tom, MD EyeWorld journal club tomy, lens fragmentation, and if needed, astigmatic keratotomies. Three surgeons performed the phacoemulsification using the In- finiti phacoemulsification machine (Alcon). An SA60AT IOL (Alcon) was placed in the capsular bag in all cases possible. Uncorrected distance visual acuity at 4 weeks was the primary outcome measure. Intra- and postoperative complications, refraction, corneal thickness, endo- thelial cell loss, central foveal thick- ness, quality of life outcomes, and patient-reported quality of vision preoperatively and at 4 weeks after surgery were selected as secondary outcome measures. Overall, there was an astound- ing absence of difference in out- comes between the two groups: unaided and pinhole corrected VA (logMAR) (p=1), increase in CCT (p=0.5), ECC loss (p=0.76), refractive mean spherical equivalent error (p=0.74), change in central foveal A ge-related cataract is the leading cause of visual impairment worldwide, 1 and cataract surgery is one of the safest and most commonly performed oper- ations worldwide. 2 Phacoemulsi- fication was first introduced more than 40 years ago and is currently the predominant surgical technique employed for cataract surgery. Each step during surgery is important, and a precise capsulorhexis is key for a successful cataract surgery, not only during the procedure itself but also for optimum long-term vision quality, as it leads to better IOL centration and less IOL tilt, 3,4 which is especially important in cases of premium IOLs. Femtosecond laser platforms can be used for creation of the corneal incisions, capsulotomy and lens fragmentation. Although the potential advantages of femto- second laser-assisted cataract surgery (FLACS) are in theory broad and include greater safety, better visual outcomes, and reduced complica- tions through greater precision and reproducibility compared to proce- dures completed by hand, the evi- dence of the superiority of FLACS vs. conventional phacoemulsification surgery (CPS) remains controversial. A meta-analysis of 9 randomized controlled trials (RCTs) and 15 cohort studies including FLACS vs. CPS showed that FLACS appeared to be safer, faster, and achieved better visual outcomes than CPS, 5 but a Cochrane meta-analysis of 16 RCTs published in 2016 could not deter- mine the equivalence or superiority of FLACS compared to CPS due to the low to very low certainty of the evidence available from these stud- ies. 6 They argue that evidence is un- certain because current studies have not been large enough to provide a reliable answer to this question. In "A randomized controlled trial comparing femtosecond laser assisted cataract surgery vs. conven- tional phacoemulsification surgery," Roberts et al. attempt to address this question by performing a large, prospective, randomized, interven- tional case-controlled trial at a single center to compare the clinical results of CPS to FLACS. The study included 400 eyes of 400 patients undergoing cataract surgery, randomized to re- ceive CPS or FLACS in equal propor- tions. Parameters that were mea- sured included visual acuity (VA), refractive error, biometry by the IOLMaster 500 (Carl Zeiss Meditec, Jena, Germany), corneal topography and central corneal thickness (CCT) by Pentacam (Oculus, Wetzlar, Germany), endothelial cell count (ECC) by the Topcon SP-3000 Spec- ular Microscope (Topcon Medical Systems, Oakland, New Jersey), and macular optical coherence tomogra- phy (OCT) by the Spectralis SD-OCT (Heidelberg Engineering, Heidelberg, Germany). Quality of life outcomes were measured with EuroQOL's EQ- 5D and patient reported quality of vision with Cat-PROM5. Two surgeons performed the FLACS treatment using the LenSx femtosecond laser (Alcon, Forth Worth, Texas). The femtosecond laser was used to perform capsulo- Review of "A randomized controlled trial cataract surgery vs. conventional University of Washington Medicine Eye Institute ophthalmology residents, from left: Alex Solomon, MD, Mai Tsukikawa, MD, Kellie Satterfield, MD, Elysse Tom, MD, John Davis, MD, Marcela Estrada, MD, Shu Feng, MD, Gautam Vangipuram, MD, Jocelyn Lam, MD, Parker Faith, MD, Karine Duarte Bojikian, MD, Joanne Ho, MD, Brandon Erickson, MD, Ashley Roldan, MD, and Nicholas Chan, MD Source: University of Washington Parisa Taravati, MD, residency program director, Department of Ophthalmology, University of Washington This month's JCRS includes the largest randomized clinical trial of FLACS vs. manual phaco to date, apart from the French FEMCAT study. I invited the University of Washington residents to review this study. —David F. Chang, MD, EyeWorld journal club editor

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