Objective: To describe the intraoperative complications and to
evaluate the learning curve with femtosecond laser cataract surgery.
Design: Prospective, consecutive cohort study.
Participants: The first 200 eyes undergoing femtosecond laser cataract
surgery and refractive lens exchange in a single center.
Methods: The initial 200 eyes undergoing cataract surgery between
April 2011 and June 2011 by 6 surgeons were included in the study. The cases
underwent anterior capsulotomy, lens fragmentation, and corneal incisions with
the femtosecond laser. The procedure was completed by phacoemulsification and
insertion of an intraocular lens. Data were collected about patient
demographics, preoperative investigations and intraoperative complications. The cases were divided into 4 groups—group
1 included the first 50 cases, group 2 included cases 51 through 100, group 3
included cases 101 through 150, and group 4 included cases 151 through 200—and
were analyzed.
Results: The mean age of patients included was 69.2
+/- 9.8 years. Of the 200 eyes, 74.5%
underwent a complete procedure of laser capsulotomy, lens fragmentation, and
corneal incisions. Five eyes had suction breaks during the laser procedure that
led to the remainder of the laser procedure being aborted. Twenty-one (10.5%)
eyes showed the presence of small anterior capsular tags. The number of eyes
with free-floating capsulotomies was 35 (17.5%). The other complications during
the study were anterior radial tears (n = 8; 4%), posterior capsular ruptures (n =
7; 3.5%), and dropped nucleus (n =
4; 2%). A significant difference was noted among the
sequential groups with respect to the number of docking attempts (P<0.001), miosis after the laser procedure (P<0.001), and free-floating capsulotomies (P<0.001), suggesting an improving learning curve. The surgeons
with prior experience with femtosecond lasers had fewer complications in the
first 100 cases (P<0.001). No difference in complications was observed after
the initial 100 cases.
Conclusions: In this case series, there was a clear learning curve
associated with the use of femtosecond lasers for cataract surgery. Adjustment to
surgical technique and prior experience with a femtosecond laser seemed to
flatten the learning curve.
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