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Visual and Refractive Outcomes in Manual versus Femtosecond Laser–Assisted Cataract Surgery : A Single-Center Retrospective Cohort Analysis of 1838 Eyes
Ophthalmology ( IF 13.7 ) Pub Date : 2018-03-06
Thomas A. Berk, Matthew B. Schlenker, Xavier Campos-Möller, Austin M. Pereira, Iqbal Ike K. Ahmed

Purpose

Femtosecond laser–assisted cataract surgery (FLACS) has emerged as an alternative to manual cataract surgery (MCS) for corneal incision and capsulorhexis creation, as well as nuclear fragmentation. This study compares postoperative refractive and visual outcomes in eyes receiving MCS or FLACS.

Design

Single-center, comparative, retrospective cohort analysis.

Participants

Consecutive eyes receiving FLACS and MCS from July 1, 2012, to July 31, 2015, at a single tertiary care center.

Methods

Demographic data, ocular history, preoperative measurements and biometry, and postoperative surgical results were retrospectively obtained and statistically analyzed using a generalized linear mixed model adjusting for differences in baseline characteristics and within-patient correlation. A 2-tailed P value <0.05 was considered statistically significant throughout the study.

Main Outcome Measures

Percentage of eyes achieving absolute error (AE) ≤0.5 diopters (D). Secondary outcomes included percentage of eyes with AE ≤0.25 D and ≤1.0 D, and percentage of distance-targeted eyes achieving uncorrected distance visual acuity (UDVA) of 20/20 or better, 20/25 or better, and 20/30 or better.

Results

A total of 883 eyes received MCS and 955 received FLACS among 1089 patients. Some 82.6% of FLACS eyes and 78.8% of MCS eyes had ≤0.5 D of AE at 3 weeks, representing an adjusted odds ratio (OR) of 1.28 (95% confidence interval [CI], 0.98–1.66) of FLACS relative to MCS being within target. Some 97.1% of FLACS and 97.2% of MCS eyes had ≤1.0 D of AE (OR, 0.96; 95% CI, 0.57–1.60) and 49.3% of FLACS and 46.3% of MCS eyes, ≤0.25 D of AE (OR, 1.13; 95% CI, 0.91–1.39). Factors predictive of a favorable refractive outcome included axial length between 22 and 24.8 mm, receiving a toric intraocular lens, less preoperative cylinder, and greater preoperative average keratometry. There was no significant difference in the percentage of patients targeted for distance who achieved UDVA of 20/20 or better (P = 0.30), 20/25 or better (P = 0.06), or 20/30 or better (P = 0.66) vision.

Conclusions

Postoperatively, there was no statistically significant difference found between eyes undergoing FLACS and eyes undergoing MCS with respect to refractive and visual outcomes.



中文翻译:

人工与飞秒激光辅助白内障手术的视觉和屈光结果 :对1838只眼的单中心回顾性队列分析

目的

飞秒激光辅助性白内障手术(FLACS)可以替代人工白内障手术(MCS)进行角膜切口和撕囊术以及核碎裂。这项研究比较接受MCS或FLACS的眼睛的术后屈光和视觉结果。

设计

单中心,比较性,回顾性队列分析。

参加者

从2012年7月1日至2015年7月31日,在一家三级护理中心连续接受FLACS和MCS手术。

方法

回顾性地获得人口统计学数据,眼病史,术前测量和生物测定以及术后手术结果,并使用广义线性混合模型对基线特征和患者内相关性之间的差异进行调整,以进行统计学分析。在整个研究中2尾P值<0.05被认为具有统计学意义。

主要观察指标

达到绝对误差(AE)≤0.5屈光度(D)的眼睛百分比。次要结果包括AE≤0.25D和≤1.0D的眼睛百分比,以及达到20/20或更高,20/25或更高以及20/30或更高的未矫正远视力(UDVA)的距离目标眼睛的百分比。

结果

在1089位患者中,共有883眼接受了MCS,而955眼接受了FLACS。3周时,FLACS眼睛的82.6%和MCS眼睛的78.8%的AE≤0.5 D,这意味着相对于MCS,FLACS的调整后的优势比(OR)为1.28(95%置信区间[CI],0.98–1.66)在目标范围内。约97.1%的FLACS和97.2%的MCS眼睛的AE≤1.0 D(OR,0.96; 95%CI,0.57-1.60)和49.3%的FLACS和46.3%的AE≤0.25 D(OR, 1.13; 95%CI,0.91-1.39)。预测良好屈光结果的因素包括22至24.8 mm的轴向长度,接受复曲面人工晶状体,术前柱镜较少和术前平均角膜曲率较大。达到UDVA为20/20或更高的远距离目标患者百分比没有显着差异(P = 0.30),20/25或更高(P  = 0.06)或20/30或更高(P  = 0.66)视力。

结论

术后,在屈光和视觉结局方面,接受FLACS的眼睛和接受MCS的眼睛之间没有统计学上的显着差异。

更新日期:2018-03-07
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