| Objective Capsulorhexis is an important step determining the cataract surgery to be successful or failing.The anterior capsule in different diameter not only influence the difficulty of surgical operation,but also has a directly impact on the effective lens position,the stability in the eyes and the function of the IOL.Capsulorhexis through femtosecond laser is more accurate and more regular than manual.It provides good visual quality for the patients who are implanted with premium IOL in the cataract surgery.In this study,patients with normal tension of the suspensory ligament were implanted with Acry Sof? Toric IOL.The anterior capsule incision was fabricated by femtosecond laser while the anterior and posterior capsule was polished during the operation.The intraocular stability and visual quality of IOL with different diameters before and after operation were observed.We recorded CDE intraoperative and visual acuity,corneal endothelial cell density,corneal curvature and complications at different time postoperative.Then we evaluated the safety and efficacy of cataract surgery assisted by femtosecond laser.Methods 1.A prospective control study.60 eyes with age-related cataract that implanted with Toric IOL by femtosecond laser were included.They were divided into two groups due to the anterior capsule diameter.One group is 5.2mm and the other group is 5.6mm,while each group included 30 eyes.The IOL and operation parameters are determined by the caculator online preoperative,and images were captured by Verion digital guided system in the operation,while the operation completed by Len Sx and Centurion.UCVA,BCVA,diopter,corneal endothelium cell counting,corneal curvature,intraoperative and postoperative complications of 1 week,1 month,3 months,6 months were observed in follow-up visit.x2-test and t-test were used to analyze postoperative visual acuity,CDE value,SIA and postoperative astigmatism in two groups of patients.Corneal endothelial cells counting were compared by repeated measures analysis of variance.2.A prospective control study.The subjects,methods of operation and the time of follow-up were the same as the first parts.Pentacam was used to measure and calculate IOL tilt and decentration,ELPRMS and anterior capsule diameter.Image-Pro Plus was used for image analysis.The difference of IOL tilt,decentration,ELP means between the two groups was analyzed by repeated measures analysis of variance.The diameter of the anterior capsule was analyzed by one-way analysis of variance,and ELPRMS was t-test.The total high-order aberration,spherical aberration,coma and MTF of 3mm and 6mm pupil were measured by i Trace.Axial position of Toric IOL was measured by slit lamp light band method and we calculated the axial rotation degrees.The actual astigmatism axis of Toric IOL transformed from the astigmatism axis of eye aberration was compared with that of slit lamp light band method.All the parameters were compared by the repeated measures of variance analysis.3.Animal study.Four New Zealand White Rabbits were randomly divided into two groups,and one eye was randomly picked for each rabbit.Clear corneal incision was made using Len Sx femtosecond laser and disposable 45° ophthalmic scalpels for two groups,respectively.One week and one month after surgery,one eye was selected for each group.Corneal morphologic and histocytologic changes were observed using AS-OCT and confocal microscope,and histocytologic changes in the incision area were observed using transmission electron microscope.Results 1.5.2mm and 5.6mm diameter of anterior capsules were maded by femtosecond laser.Number of UCVA and BCVA of 5.2mm group of patients after 1 week,1 month,3 months,6 months were ?60% and ?75% than 5.6mm group,the difference between the two groups were not statistically significant.There was no significant difference in the CDE values between the two groups.The corneal endothelium cell density of patients decreased and there was no significant difference statistically.Corneal endothelial cell loss rate of 1 month was higher,decreasing gradually with time.There was no significant difference in residual astigmatism between the two groups at different time points.The residual astigmatism of two groups was(0.40±0.32)D and(0.42±0.26)D at 6 months after operation,respectively,which was reduced by 84.25% and 82.93% compared with that before operation.At 6 months after operation,SIA in group 5.2mm was(0.31±0.15)D,and(0.28±0.14)D in group 5.6mm,and there was no statistical difference between the two groups.2.IOL tilt of two groups at 3 months was the largest,respectively(2.36±0.90)°,(2.62±0.61)°.IOL decentration at 6 months of 5.2mm group was(0.24±0.09)mm,was the largest,while 5.6mm group at 3 months largest,(0.28±0.08)mm.The tilt degree and decentration of 5.6mm group were greater than those of 5.2mm group at each time point.There was no significant difference between the two groups.There was no correlation between the tilt angle and the decentration in the two groups.There was no significant difference in the mean ELP between the two groups at each time point.There was a large variation of ELP in 5.6mm than 5.2mm group from 1 week to 6 months postoperation,the difference between the two groups was statistically significant.The anterior capsule diameter at each time point in the two groups were slightly larger than the preset,with no significant difference statistically intragroup.The diameter at 1 week was the largest,5.2mm group was(5.28±0.17)mm,5.6mm group was(5.71±0.18)mm.There was no correlation between ELP and diameter.3.There was no significant difference in the total ocular and intraocular total high-order aberration,spherical aberration,coma and MTF between two groups of 3mm and 6mm.4.The axial rotation degree of Toric IOL measured by slit lamp at each time point after operation in group 5.6mm was higher than 5.2mm group,and the difference between the two groups were not statistically significant.Six months after surgery,axial rotation degree reached the maximum,5.2mm group was(3.17±2.42)°,5.6mm group was(3.57±2.10)°.Toric IOL axis of two group patients at each time point after operation measured by i Trace method was linearly correlated with slit lamp light band method.After 6 months,the number of axial deviation <5° in two methods was 21(70%)and 23(76.7%).5.The length of clear corneal incision made by femtosecond laser and observed by AS-OCT was close to the default before surgery,and the incision was trim and regular.The incision made by scalpels variated greatly,and the reaction of stroma and endothelial cells were more serious.Observed by the confocal microscope,the healing time and degree of epithelial cells of clear corneal incision made by two methods was roughly the same.In stroma,the incision scar made by femtosecond laser was narrower than that made by scalpels.However,in 1 week after operation,stromal cells around the incision activated more obvious in femtosecond laser group,than in scalpel group.In 1 month after surgery,stromal cells regain the resting state in both groups.Observed by the transmission electron microscope,stromal fiber in incision area arranged more random,and the injury of stromal corneal cells was more severe in femtosecond laser group than in the scalpel group.Conclusions 1.Femtosecond laser cataract phacoemulsification combined with anterior capsule polishing combined with Acry Sof? Toric IOL was safety and efficacy.2.Femtosecond laser cataract phacoemulsification combined with anterior capsule polishing,5.2mm group was better than 5.6mm group about the intraocular stability.There was no significant difference between 5.2mm group and 5.6mm group about the visual quality of Acry Sof? Toric IOL under femtosecond laser capsulotomy.3.The axial rotation degree of Acry Sof? Toric IOL of 5.6mm group measured by slit lamp light band method was larger than that of 5.2mm group,and the difference was not statistically significant.The results of i Trace measuring the axial position of Acry Sof? Toric IOL were reliable,with a good consistency with the slit lamp light band method.4.The degree of scarring and morphological changes of clear corneal incision made by femtosecond laser was smaller than that made by scalpels.However,femtosecond laser caused more damage to the stromal fiber and tissue cells of the incision area,and the cell activation around the incision was more obvious. |
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