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   Table of Contents      
LETTER TO THE EDITOR
Year : 2018  |  Volume : 66  |  Issue : 2  |  Page : 344

Comment on: Femtosecond laser-assisted cataract surgery versus 2.2-mm clear corneal phacoemulsification


1 Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
2 Guru Nanak Eye Centre, New Delhi, India

Date of Web Publication30-Jan-2018

Correspondence Address:
Dr. Sudarshan Khokhar
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1143_17

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How to cite this article:
Sen S, Khokhar S, Aron N, Saini P. Comment on: Femtosecond laser-assisted cataract surgery versus 2.2-mm clear corneal phacoemulsification. Indian J Ophthalmol 2018;66:344

How to cite this URL:
Sen S, Khokhar S, Aron N, Saini P. Comment on: Femtosecond laser-assisted cataract surgery versus 2.2-mm clear corneal phacoemulsification. Indian J Ophthalmol [serial online] 2018 [cited 2019 Dec 8];66:344. Available from: http://www.ijo.in/text.asp?2018/66/2/344/224067



Sir,

While congratulating the authors of “Femtosecond laser-assisted cataract surgery versus 2.2-mm clear corneal phacoemulsification” for elaborately comparing the outcomes of femtosecond laser-assisted cataract surgery (FLACS) with conventional method, we would like to bring to light certain points which we thought might be important in this context.[1]

The authors found that 1-month postoperative endothelial cell loss (ECL) was higher with FLACS with no difference in postoperative central corneal thickness (CCT), without mentioning the intergroup P value. We applied parametric statistics to arrive at the intergroup P = 0.58 comparing the final CCT at 4 weeks. However, a percentage change of CCT in each group with comparative statistics should have been mentioned to arrive at the abovementioned conclusion.

Although the authors have found a significantly higher ECL with FLACS, they have not mentioned the phacotorsional energy measured as cumulative dissipated energy which has significant effect on ECL apart from fluid usage or effective phaco time.[2] Phaco energy and time are the most important factors for endothelial damage, and FLACS may be beneficial by omitting need to sculpt and/or chop the nucleus, with similar results as studies comparing phaco chop with divide-conquer technique.[3],[4] They have also not specified which mode of phacoemulsification was used; however, they did mention about the effective phaco time being lesser in FLACS (P< 0.001). The meta-analysis by Chen et al. did not find any reduction in ECL or CCT rise with FLACS as against one by Popovic et al. which found a significant reduction of ECL with no difference in surgical time.[5]

In addition, an analysis by grade of cataract may be undertaken to further analyze the ECL in the harder grades over the lower ones to finally conclude, in which group of patients FLACS may be effectively a better option. We await a response eagerly.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ranjini H, Murthy PR, Murthy GJ, Murthy VR. Femtosecond laser-assisted cataract surgery versus 2.2 mm clear corneal phacoemulsification. Indian J Ophthalmol 2017;65:942-8.  Back to cited text no. 1
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2.
Khokhar S, Aron N, Sen S, Pillay G, Agarwal E. Effect of balanced phacoemulsification tip on the outcomes of torsional phacoemulsification using an active-fluidics system. J Cataract Refract Surg 2017;43:22-8.  Back to cited text no. 2
[PUBMED]    
3.
Pirazzoli G, D'Eliseo D, Ziosi M, Acciarri R. Effects of phacoemulsification time on the corneal endothelium using phacofracture and phaco chop techniques. J Cataract Refract Surg 1996;22:967-9.  Back to cited text no. 3
    
4.
Park J, Yum HR, Kim MS, Harrison AR, Kim EC. Comparison of phaco-chop, divide-and-conquer, and stop-and-chop phaco techniques in microincision coaxial cataract surgery. J Cataract Refract Surg 2013;39:1463-9.  Back to cited text no. 4
[PUBMED]    
5.
Chen X, Xiao W, Ye S, Chen W, Liu Y. Efficacy and safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract: A meta-analysis of randomized controlled trials. Sci Rep 2015;5:13123.  Back to cited text no. 5
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