Léda Rayssa Medeiros, Machado Daniela Cristina Schroff, Hida Wilson Takashi, Motta Antônio Francisco Pimenta, Pacini Thiago de Faria, Amorim Rivadavio Fernandes
Department of Medical Sciences, Universidade de Brasília (UnB), Brasília, DF, Brazil.
Department of Ophthalmology, Luz Hospital de Olhos e Laser, Goiânia, Goiás, Brazil.
Clin Ophthalmol. 2023 Jun 19;17:1709-1716. doi: 10.2147/OPTH.S408717. eCollection 2023.
To analyze whether femtosecond laser-assisted surgery leads to less cumulative dissipated energy (CDE) and decreased endothelial cell loss compared to conventional surgery.
This non-blinded, non-randomized, quasi-experimental clinical trial was conducted at one center and involved one surgeon. Patients with cataracts and 50-80 years old were included, and the exclusion criteria were radial keratotomy, trabeculectomy, drain tube implant, corneal transplant, posterior vitrectomy, and re-implantation of intraocular lens. In total, 298 patients were recruited between October 2020 and April 2021, and the data collected included sex, laterality, age, ocular comorbidities, systemic comorbidities and CDE. An endothelial cell count was performed before and after surgery. Patients were divided according to femtosecond laser-assisted phacoemulsification or conventional phacoemulsification. The femtolaser patients were submitted to the equipment, and then, immediately after treatment, phacoemulsification surgery was performed. In the conventional method, the "divide and conquer" technique was used. The statistical analysis was made using an analysis of covariance linear model, using SAS version 9.4 (SAS Institute, Inc., 1999). Values with p < 0.05 were considered significant.
A total of 132 patients were analyzed. The only statistically relevant predictors of CDE were the severity of the cataract (p < 0.0001) and age of ≥75 years (p = 0.0003). The following factors were not significant: technique with or without laser (p = 0.6862), sex (p = 0.8897), systemic arterial hypertension (p = 0.1658), and diabetes (p = 0.9017). Grade 4 cataracts were associated with higher CDE than grade 3 cataracts, which in turn were associated with higher CDE than grade 2 cataracts. A comparison of pre- and post-operative specular microscopy with and without laser revealed no significant discrepancy (p = 0.5017).
Femtosecond laser-assisted cataract surgery did not reduce CDE or endothelial cell loss compared to conventional surgery regardless of severity.
分析与传统手术相比，飞秒激光辅助手术是否会导致更少的累积消散能量（CDE）和更低的内皮细胞损失。
本非盲、非随机、准实验性临床试验在一个中心进行，由一名外科医生操作。纳入年龄在50至80岁的白内障患者，排除标准为放射状角膜切开术、小梁切除术、引流管植入、角膜移植、玻璃体后段切除术和人工晶状体再植入。2020年10月至2021年4月期间共招募了298例患者，收集的数据包括性别、患侧、年龄、眼部合并症、全身合并症和CDE。手术前后进行内皮细胞计数。患者根据飞秒激光辅助超声乳化术或传统超声乳化术进行分组。接受飞秒激光治疗的患者先使用设备，然后在治疗后立即进行超声乳化手术。传统方法采用“分而治之”技术。使用SAS 9.4版（SAS Institute, Inc., 1999）的协方差线性模型进行统计分析。p < 0.05的值被认为具有统计学意义。
共分析了132例患者。CDE的唯一具有统计学相关性的预测因素是白内障的严重程度（p < 0.0001）和年龄≥75岁（p = 0.0003）。以下因素不具有统计学意义：是否使用激光技术（p = 0.6862）、性别（p = 0.8897）、系统性动脉高血压（p = 0.1658）和糖尿病（p = 0.9017）。4级白内障比3级白内障的CDE更高，而3级白内障又比2级白内障的CDE更高。有激光和无激光情况下手术前后镜面显微镜检查的比较显示无显著差异（p = 0.5017）。
与传统手术相比，无论严重程度如何，飞秒激光辅助白内障手术均未减少CDE或内皮细胞损失。
