Mayer W J, Klaproth O K, Ostovic M, Hengerer F H, Kohnen T
Klinik für Augenheilkunde, Goethe Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
Ophthalmologe. 2014 Dec;111(12):1172-7. doi: 10.1007/s00347-014-3043-y.
This study was designed to evaluate the effectiveness and safety of femtosecond laser-assisted lens surgery depending on interface design and laser pulse energy settings.
In this non-randomized, consecutive case series200 eyes underwent femtosecond laser-assisted (LenSx, Alcon) lens surgery between November 2012 and June 2013. Group 1 consisted of 85 eyes with 60 cataracts and 25 refractive lens exchanges (RLE) which were treated with a curved direct contact interface, and group 2 consisting of 115 eyes with 72 cataracts and 43 RLEs treated with a modified interface using an additional soft contact lens (SoftFit™, Alcon) between the corneal surface and the interface. The degree of opacity of the lens in cataract eyes was measured with a Scheimpflug camera. Afterwards, phacoemulsification was performed with intraocular lens (IOL) implantation in all eyes. Primary endpoints were the effective phacoemulsification time (EPT), the average laser treatment time and the occurrence of intraoperative complications.
The mean EPT in group 1 was 1.62 ± 1.12 s (cataract 1.94 ± 1.31 s, RLE 1.29 ± 1.01 s) and in group 2 the mean EPT was 1.66 ± 0.92 s (cataract 1.98 ± 1.28 s, RLE 1.33 ± 1.22 s, p = 0.32 between groups). The laser treatment lasted on average 48.90 ± 2.45 s (group 1) and 49.70 ± 2.87 s (group 2) with an average lens fragmentation thickness of 3401.48 ± 401.12 µm (all groups). In four cases of group 1, a second applanation of the interface was necessary. Furthermore, one anterior capsule tear, 39 cases of intraoperative wrinkling of the corneal surface and 21 cases in which the corneal incision had to be opened manually were documented in group 1. In group 2 no second applanation of the interface, no anterior capsule tears and no corneal wrinkling but 9 cases with a manual opening of corneal incisions were documented (p < 0.01 between groups).
The minor intraoperative complications of the femtosecond laser technique investigated could be significantly reduced using an optimized interface and reduced laser pulse energy.
本研究旨在根据界面设计和激光脉冲能量设置评估飞秒激光辅助晶状体手术的有效性和安全性。
在这个非随机、连续病例系列研究中，200只眼于2012年11月至2013年6月接受了飞秒激光辅助（LenSx，爱尔康）晶状体手术。第1组由85只眼组成，其中有60例白内障和25例屈光性晶状体置换（RLE），采用弯曲直接接触界面进行治疗；第2组由115只眼组成，其中有72例白内障和43例RLE，在角膜表面与界面之间使用额外的软性接触镜（SoftFit™，爱尔康）改良界面进行治疗。使用Scheimpflug相机测量白内障眼中晶状体的混浊程度。之后，所有眼均进行超声乳化白内障吸除联合人工晶状体（IOL）植入术。主要终点为有效超声乳化时间（EPT）、平均激光治疗时间和术中并发症的发生情况。
第1组的平均EPT为1.62±1.12秒（白内障为1.94±1.31秒，RLE为1.29±1.01秒），第2组的平均EPT为1.66±0.92秒（白内障为1.98±1.28秒，RLE为1.33±1.22秒，两组间p = 0.32）。激光治疗平均持续48.90±2.45秒（第1组）和49.70±2.87秒（第2组），所有组的晶状体碎片平均厚度为3401.48±401.12微米。第1组有4例需要再次压平界面。此外，第1组记录到1例前囊膜撕裂、39例术中角膜表面皱襞和21例需要手动打开角膜切口的情况。第2组未记录到再次压平界面、前囊膜撕裂和角膜皱襞，但有9例手动打开角膜切口的情况（两组间p < 0.01）。
使用优化的界面和降低激光脉冲能量可显著减少所研究的飞秒激光技术的术中轻微并发症。
