| Objective:1、 To quantify changes in cumulative dissipated energy during surgery and corneal endothelial cell loss in patients having standard phacoemulsification compared with femtosecond laser-assisted cataract removal. 2、 To investigate the corneal astigmatism and visual function in patients having standard phacoemulsification compared with femtosecond laser-assisted cataract removal. 3、 We applied the device in patients with complicated cataract, and did the preliminary observation, trying to explore the advantage and safety of the equipment in special cases.Methods:1、 Prospective cohort study.One hundred and sixty seven(170 eyes) cases were collected from April 2013 to October 2013. They were divided into two groups according to different types of operation, femtosecond laser-assisted(FLA)group 68 cases(70 eyes), underwent femtosecond laser assisted cataract surgery, combined with intraocular lens implantation, in the traditional ultrasonic emulsification(TUE) group, ninty nine cases(100 eyes), underwent the traditional ultrasonic emulsification cataract combined with intraocular lens implantation,and their clinical manifestations were summarized and analyzed,including age,sex,lens opacities classification,preoperative corneal endothelial cell count, cumulative dissipated energy during surgery,and postoperative corneal endothelial cell count etc. 2、 Prospective cohort study.One hundred and twenty cases were collected from November 2013 to August 2014. They were divided into three groups according to different types of operations, the operations include femtosecond laser assisted cataract surgery combined with intraocular lens implantation and traditional ultrasonic emulsification cataract combined with intraocular lens implantation,and their clinical manifestations weresummarized and analyzed,including age,sex,lens opacities classification,preoperative corneal endothelial cell count, uncorrected visual acuity, best corrected visual acuity, central corneal thickness and corneal curvature etc. Using Vector Analysis to calculate Surgically induced astigmatism. Pared-samples t-test is for comparision in groups and independent-samples t-test is for comparision between groups. With P < 0.05 for the difference was statistically significant. 3、 Collect 51 cases(60 eyes) of special cataract patients:(1) 11 cases(12 eyes) accompanied with Fuchs corneal endothelial dystrophy,(2)10 cases(11 eyes) accompanied with the lens subluxation,(3)13cases(14 eyes)were the intumescent cataract,(4) 17 cases(23 eyes) accompanied with high myopia, constituent ratio of 20.00%, 18.33%, 20.00% and 18.33% respectively. The collection was from October 2013 to October 2014 in Tianjin medical university eye hospital.The surgery were done by the same physician. Preoperative routine slit lamp, intraocular pressure, corneal endothelial cell count, the optical biological measurement(Len STAR) and A ultrasound measuring axial length and lens diopter, B ultrasonic and macular area OCT examination. Postoperative 1 day, 1 week, 1 month, 3 months follow-up of patients with visual acuity, intraocular pressure and the front section, line of corneal endothelial count, B ultrasonic and macular area OCT examination, and record the intraoperative and postoperative complications.Results:1、 The mean CDE of FLA group was 6.48±4.62 in patients with lens opacitiesⅡand 17.56±8.27 in Ⅲ;respectively,in TUE group the CDE was 8.62±3.90 and 22.69 ± 8.06.Three-month follow-up postopertively,the mean endothelialcell loss was 4.78%±2.45% in FLA group with lens opacitiesⅡ and 10.64±7.12% in patients with lens opacities Ⅲ, 7.69%±4.45% and 16.26%±6.51%,respectively, in TUE group. Comparison between the two groups, the difference is statistically significant. 2、 The corneal astigmatism on the first day after operation was significant in all groups, later decreased gradually and stabilized at 4 weekspost-operation in group A and at 2~3 weeks post-operation in group B&C, there was no significant difference, statistically( All P > 0.05). The surgically induced astigmatism of Group A 、 B and C at 3 months post-operation was(0.33±0.13)D、(0.36±0.13)D,(0.31±0.10)D for right eyes,(0.42±0.12)D、(0.51±0.10)D,(0.47±0.11)D for left eyes, there was no statistically significant(All P>0.05).Corneal thickness in 3 groups pre-operation and 1 day,1 week,2 weeks,3 weeks,1month,3 months post-operation there was no statistically significant(All P>0.05). 3、(1) The first postoperative day 52 eyes uncorrected visual acuity> 0.3, 39 eyes best corrected visual acuity > 0.8, in which more focus IOL implanted(+ 3 D) in 7 eyes, near vision > 0.5/30 cm. Three months postoperatively, the above data basic remain unchanged.(2) the first postoperative day there were 5 eyes showed obvious corneal edema, 2 eyes appeared intraocular pressure rises > 30 mm Hg, 2 eyes with posterior capsule tore and IOL implanted, the rest of the patients were not significant corneal edema, IOL center position, and IOP in the normal range.(3) all of the patients in the cumulative dissipated energy was 6.75± 4.28, corneal endothelial cell loss was 6.69± 4.47%, of which 11 cases(12 eyes) with Fuchs corneal endothelial dystrophy sufferers CDE value was 3.03± 2.07, the corneal endothelial cell loss was 4.78% plus or minus 2.45%.(4) B ultrasonic and OCT show, 25 eyes(41.67%) patients in preoperative is partially or completely posterior vitreous detachment,14 eye for high myopia patients, 56% of the total number of patients with high myopia.Three months later, 9 eyes(25.71%) developed new PVD, 8 eyes(32.00%) on the basis of the original part of PVD degree aggravating or into a completely PVD. All eyes had no retinal detachment and vitreous hemorrhage occurred in patients with serious complications; All of the patients did not appear obvious edema in the macular area.Conclusion:1、 Femtosecond laser-assisted cataract surgery system could decrease the CDE during surgery. It has a lower damage to corneal endothelial cell comparedwith conventional surgery. 2、 The surgically induced astigmatism is very small after two types of operations. Femtosecond laser-assisted cataract surgery has more quickly refractive status stability, both types of operations were safe and effective. Patients could obtain satisfying UCVA in the early postoperative period. 3、 The femtosecond laser assisted cataract system can be used in special cases, making the difficult and high-risk surgery easier and safer. |
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