Eyeworld

EW RESIDENTS 68 December 2017 astigmatic correction (8.6%). Tra- ditional cataract surgical complica- tions occurred in 0.7%. FLACS-spe- cific surgical complications occurred in 2.2% and were most commonly related to the corneal incision. Postoperatively, refractive outcomes were favorable compared to manual phacoemulsification. 4 The mean postoperative CDVA was logMAR 0.04, with logMAR 0.3 or better achieved in 96.2% of cases. Spherical equivalent refractive error was within ±1.0 D of prediction in 91.8% of cases. Complications were reported in 3.3% over an average follow-up period of 34 days. These included optic axis opacities (0.8%), central corneal edema (0.4%), and uncontrolled rise of intraocular pres- sure (0.1%). An insightful aspect of this re- port is the analysis conducted on pa- tients stratified by preoperative visu- al acuity. Specifically, patients were divided into five groups by baseline Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO): baseline characteristics, surgical procedure, and outcomes." Eighteen cataract surgery clinics in 10 countries participated in the study. Patients were deemed candi- dates for FLACS according to each clinic's routine practices. Preoper- ative characteristics, surgical com- plications, and outcomes data for FLACS patients was reported to the European Registry of Quality Out- comes for Cataract and Refractive Surgery (EUREQUO). Data was col- lected for 3,379 consecutive FLACS patients between 2013 and 2015. Preoperative characteristics for FLACS patients included: average age 64.4 years; gender 57.8% female; ocular comorbidity in 19.1%. Intraoperatively, the femtosec- ond laser was used primarily for combined capsulotomy and nucleus fragmentation (94.1%). The laser was used less frequently for corneal incision creation (33.9%) or corneal F emtosecond laser-assisted cataract surgery (FLACS) was approved by the U.S. Food and Drug Adminis- tration in 2010. 1 FLACS uses laser technology to automate and standardize several key steps of phacoemulsification cataract surgery including corneal incision creation, capsulorhexis, and lens fragmen- tation. Though FLACS reduces phacoemulsification time 2 and pro- vides theoretic benefits over manual phacoemulsification, complication rates and refractive outcomes for FLACS have been demonstrated to be equivalent to manual phacoemul- sification techniques. 3 What is less understood is the degree to which FLACS efficacy varies with baseline characteristics of operative eyes. This issue is examined in a cohort of FLACS patients with differing base- line visual acuities by Lundström et al. in a study titled "Femtosec- ond laser-assisted cataract surgeries (FLACS) reported to the European Review of "Femtosecond laser-assisted cataract surgeries (FLACS) reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO): baseline characteristics, surgical procedure, and outcomes" continued on page 70 Jeffrey Goshe, MD, residency program director, Cole Eye Institute, Cleveland Clinic How does FLACS compare to phaco in eyes with advanced versus milder cataracts? This month, the Cleveland Clinic Cole Eye Institute's residents review this comparison that looks separately at different subgroups within the large ESCRS EUREQUO study. —David F. Chang, MD, EyeWorld journal club editor Robert Purgert, MD, PhD, resident, Cole Eye Institute, Cleveland Clinic EyeWorld journal club by Robert Purgert, MD, PhD, and Jeffrey Goshe, MD

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