Chao Howard Wen-Haur, Cheng Cheng-Kuo, Liou Shiow-Wen, Chao Hsiao-Ming
Department of Medicine, School of Medicine, Aston University, Birmingham, United Kingdom.
Department of Medical Education, Leeds University, Leeds, United Kingdom.
Front Med (Lausanne). 2025 May 1;12:1497776. doi: 10.3389/fmed.2025.1497776. eCollection 2025.
Age-related cataracts and macular pucker are increasingly common. Standard treatment combines phacoemulsification, IOL implantation and small gauge vitrectomy. Recent advancements and acceptance of femtosecond laser (FSL) assistance in cataract surgery have improved precision and outcomes. However, evidence regarding the efficacy and safety of FSL-assisted phacovitrectomy, particularly in Oriental patient populations with distinct anatomical and genetic characteristics, remain limited. This study aims to address this critical gap by comparing the safety and post-operative outcomes of 23- or 25-gauge phacovitrectomy for stage 3 macular pucker and medium density cataract with versus without FSL-assistance (FSLA), in an Oriental patient cohort.
Patients with stage 3 macular pucker and medium-density cataract were recruited and divided into two age-matched groups: group 1 ( = 13) underwent conventional phacovitrectomy without FSLA, and Group 2 ( = 13) underwent phacovitrectomy with FSLA. Evaluations included pre- and postoperative best-corrected visual acuity (BCVA; Snellen E and LogMAR), cataract surgical time, phacoemulsification energy cost, corneal wavefront data, endothelial cell density (ECD), and surgical complications.
Significant improvements in postoperative visual acuity were observed in both groups ( < 0.05), with Group 2 (FSLA) demonstrating superior outcomes (0.48 ± 0.05/-0.45 ± 0.06; Snellen E/logMAR) compared to Group 1 (0.26 ± 0.07/-0.66 ± 0.15; Snellen E/logMAR). FSLA significantly reduced surgical duration (429.46 s vs. 740.00 s) and cumulative dissipated energy (CDE; 18.90 ± 1.59 vs. 25.24 ± 1.42) without significantly altering higher-order aberrations (0.24 to 0.22 μm). Although ECD decreased postoperatively in both groups, FSLA phacovitrectomy resulted in significantly less endothelial cell loss (227.77 ± 46.85 cells/mm) compared to conventional phacovitrectomy (389.15 ± 47.87 cells/mm). No serious complications were reported in either group.
FSLA phacovitrectomy presents a safe and more efficient alternative over traditional procedures for Oriental patients with medium density nuclear cataract patients with stage 3 macular pucker. Through enhanced IOL centration, shortened surgical times and decreased ECD loss, FSLA led to superior postoperative visual outcomes compared to traditional phacovitrectomy. This study addresses a critical gap in the literature by providing evidence for the benefits of FSLA in Oriental populations, offering valuable insights into its applicability in patients with distinct anatomical variations.
年龄相关性白内障和黄斑皱襞越来越常见。标准治疗方法是将超声乳化、人工晶状体植入和小切口玻璃体切除术相结合。飞秒激光（FSL）辅助白内障手术的最新进展和应用提高了手术的精准度和效果。然而，关于FSL辅助的晶状体玻璃体切除术的有效性和安全性的证据仍然有限，特别是在具有独特解剖和遗传特征的东方患者群体中。本研究旨在通过比较23G或25G晶状体玻璃体切除术治疗3期黄斑皱襞和中度密度白内障在有和没有FSL辅助（FSLA）情况下的安全性和术后结果，填补这一关键空白。
招募3期黄斑皱襞和中度密度白内障患者，并将其分为两个年龄匹配的组：第1组（n = 13）接受无FSLA的传统晶状体玻璃体切除术，第2组（n = 13）接受有FSLA的晶状体玻璃体切除术。评估指标包括术前和术后最佳矫正视力（BCVA；Snellen E和LogMAR）、白内障手术时间、超声乳化能量消耗、角膜波前数据、内皮细胞密度（ECD）和手术并发症。
两组术后视力均有显著改善（P < 0.05），与第1组（0.26±0.07/-0.66±0.15；Snellen E/logMAR）相比，第2组（FSLA）的结果更优（0.48±0.05/-0.45±0.06；Snellen E/logMAR）。FSLA显著缩短了手术时间（429.46秒对740.00秒）和累积耗散能量（CDE；18.90±1.59对25.24±1.42），且未显著改变高阶像差（0.24至0.22μm）。虽然两组术后ECD均下降，但FSLA晶状体玻璃体切除术导致的内皮细胞损失明显少于传统晶状体玻璃体切除术（227.77±46.85个细胞/mm²）（389.15±47.87个细胞/mm²）。两组均未报告严重并发症。
对于患有3期黄斑皱襞的中度密度核性白内障的东方患者，FSLA晶状体玻璃体切除术是一种比传统手术更安全、更有效的替代方法。通过提高人工晶状体的中心定位、缩短手术时间和减少ECD损失，FSLA与传统晶状体玻璃体切除术相比，术后视力结果更优。本研究通过提供FSLA在东方人群中的益处的证据，填补了文献中的关键空白，为其在具有独特解剖变异的患者中的适用性提供了有价值的见解。
