Devience Eva X, Awidi Abdelhalim, Kalarn Sachin, DeVience Stephen, Bui Brendan, Munir Wuqaas M, Kaleem Mona A, Im Lily, Jeng Bennie H, Daoud Yassine, Saeedi Osamah J
Kaiser Permanente, Baltimore, MD, USA.
Wilmer Eye Institute at Johns Hopkins University, Baltimore, MD, USA.
Int Ophthalmol. 2023 Jan;43(1):285-292. doi: 10.1007/s10792-022-02427-x. Epub 2022 Jul 23.
To evaluate the association between postoperative intraocular pressure (IOP) reduction and phacoemulsification parameters in patients who underwent both conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS).
This was a prospective multicenter comparative study that enrolled 90 participants who underwent cataract surgery at the University of Maryland Medical System and the Wilmer Eye Institute. Patients underwent FLACS in one eye and CPS in the fellow eye. IOP was measured prior to surgery and monitored through six months postoperatively. Demographic, clinical, biometric, and intraoperative variables including cumulative dissipated energy (CDE), aspiration time, and phacoemulsification time were analyzed for any significant association with postoperative IOP. Postoperative IOP reduction was the primary outcome variable. A secondary goal of the study was to determine differences in postoperative IOP reduction between CPS and FLACS cohorts.
In total, 157 non-glaucomatous eyes were included. Using multivariable analysis, we found preoperative IOP to be consistently associated with postoperative IOP reduction in the entire cohort. At the 6-month follow-up visit, there was a 12.4% reduction in IOP (-2.2 ± 3.4 mm Hg) seen, with no statistically significant difference between FLACS and CPS (12.3% ± 19.4% vs 12.5% ± 19.3%, respectively, p = 0.32). FLACS reduced the CDE required for phacoemulsification (6.6 ± 4.4%-seconds vs 8.6 ± 6.9%-seconds, respectively, p < 0.05). CDE was a predictor of IOP response at 6 months, but subgroup analysis revealed that this trend was driven by seven eyes requiring high CDE, and for the majority of eyes, CDE did not influence the size of the decrease. The seven eyes experiencing highest CDE were less likely to show IOP reduction at 6 months.
Both FLACS and CPS resulted in similar and significant IOP reductions through 6 months after surgery. Preoperative IOP was significantly associated with IOP reduction, and CDE generally did not influence the size of the decrease.
评估接受传统超声乳化白内障手术（CPS）和飞秒激光辅助白内障手术（FLACS）的患者术后眼压（IOP）降低与超声乳化参数之间的关联。
这是一项前瞻性多中心比较研究，纳入了90名在马里兰大学医学系统和威尔默眼科研究所接受白内障手术的参与者。患者一只眼睛接受FLACS，另一只眼睛接受CPS。在手术前测量眼压，并在术后六个月进行监测。分析人口统计学、临床、生物测量和术中变量，包括累积消散能量（CDE）、抽吸时间和超声乳化时间，以确定其与术后眼压的任何显著关联。术后眼压降低是主要结局变量。该研究的次要目标是确定CPS和FLACS队列之间术后眼压降低的差异。
总共纳入了157只非青光眼眼睛。通过多变量分析，我们发现术前眼压与整个队列中的术后眼压降低始终相关。在6个月的随访中，眼压降低了12.4%（-2.2±3.4 mmHg），FLACS和CPS之间无统计学显著差异（分别为±19.4%和±19.3%，p = 0.32）。FLACS减少了超声乳化所需的CDE（分别为6.6±4.4%-秒和8.6±6.9%-秒，p < 0.05）。CDE是6个月时眼压反应的预测指标，但亚组分析显示，这一趋势是由7只需要高CDE的眼睛驱动的，对于大多数眼睛来说，CDE并不影响降低幅度的大小。经历最高CDE的7只眼睛在6个月时眼压降低的可能性较小。
FLACS和CPS在术后6个月均导致了相似且显著的眼压降低。术前眼压与眼压降低显著相关，并且CDE通常不影响降低幅度的大小。
