FLACS associated with low rate of unplanned vitrectomies

Learning curve for conducting femtosecond laser-assisted cataract surgery is 'steep and short.'

With respect to unplanned vitrectomies, femtosecond laser-assisted cataract surgery is at least as safe as a conventional phacoemulsification procedure, according to one study.

Christian Song, MD, and colleagues conducted a retrospective chart review of both FLACS and conventional phacoemulsification procedures and compared rates of unplanned vitrectomies in both groups.

“FLACS is safe to perform with a low rate of unplanned vitrectomy that is no higher than what we see with conventional phacoemulsification,” Song told Ocular Surgery News. “It’s worth noting, however, that the rate of this complication was exceptionally low with both FLACS and conventional phacoemulsification, 0.65% and 0.62%, respectively, among the surgeons captured in this study. Rates of unplanned vitrectomy are typically reported to be in the range of around 1% to 3% for conventional phacoemulsification in the peer-reviewed literature.”

Rates of vitrectomy

The researchers compared results of 2,480 consecutive FLACS procedures performed by 30 surgeons using the Catalys laser platform (Johnson & Johnson Vision) and 36,865 consecutive conventional phacoemulsification procedures performed by 47 surgeons, not only for rates of unplanned vitrectomies but also for rates of posterior capsule tear, anterior capsule tear and zonular dehiscence in eyes with unplanned vitrectomy.

Unplanned vitrectomy rates were nearly similar in both cohorts, with 0.65% of FLACS patients experiencing unplanned vitrectomies compared with 0.62% of conventional phacoemulsification patients.

Most experienced cataract surgeons can perform a consistent and appropriately sized capsulorrhexis, but not everyone is perfect 100% of the time, Song said.

“Subjectively I feel a greater level of comfort and confidence whenever I have the femtosecond laser ‘tee up’ the cataract for me such that the capsulotomy is already completed, and the nucleus is already segmented before I’ve even entered the eye,” Song said.

Song said he uses the Catalys platform in his practice.

“I feel that the laser introduces a level of precision that is simply not attainable with the human hand and that it is a useful tool in the cataract surgeon’s armamentarium, particularly with denser cataracts and when performing astigmatic and/or presbyopic correction at the time of the surgery,” he said.

Learning curve

Additionally, the rates of unplanned vitrectomies were compared between early and later cases in order to assess the learning curve of the procedure. Thresholds were set at experience with the first 10, 20 and 50 cases compared with all subsequent cases, but there was no significant difference in the rate of unplanned vitrectomies, indicating that “this learning curve is short and readily surmountable,” the researchers said.

“Just to clarify, when we say a learning curve is steep, that means a high level of skill is achievable in a short amount of time and therefore relatively easy to acquire. A common misconception is that a skill with a steep learning curve is one that is difficult to achieve, akin to rolling a heavy boulder up a steep hill, when in fact it has the opposite meaning. So, the fact that there was no significant difference in the vitreous loss rates between early and late cases would be consistent with other published studies reporting that the learning curve is steep and short,” Song said. – Robert Linnehan

Disclosure: Song reports no relevant financial disclosures.

With respect to unplanned vitrectomies, femtosecond laser-assisted cataract surgery is at least as safe as a conventional phacoemulsification procedure, according to one study.

Christian Song, MD, and colleagues conducted a retrospective chart review of both FLACS and conventional phacoemulsification procedures and compared rates of unplanned vitrectomies in both groups.

“FLACS is safe to perform with a low rate of unplanned vitrectomy that is no higher than what we see with conventional phacoemulsification,” Song told Ocular Surgery News. “It’s worth noting, however, that the rate of this complication was exceptionally low with both FLACS and conventional phacoemulsification, 0.65% and 0.62%, respectively, among the surgeons captured in this study. Rates of unplanned vitrectomy are typically reported to be in the range of around 1% to 3% for conventional phacoemulsification in the peer-reviewed literature.”

Rates of vitrectomy

The researchers compared results of 2,480 consecutive FLACS procedures performed by 30 surgeons using the Catalys laser platform (Johnson & Johnson Vision) and 36,865 consecutive conventional phacoemulsification procedures performed by 47 surgeons, not only for rates of unplanned vitrectomies but also for rates of posterior capsule tear, anterior capsule tear and zonular dehiscence in eyes with unplanned vitrectomy.

Unplanned vitrectomy rates were nearly similar in both cohorts, with 0.65% of FLACS patients experiencing unplanned vitrectomies compared with 0.62% of conventional phacoemulsification patients.

Most experienced cataract surgeons can perform a consistent and appropriately sized capsulorrhexis, but not everyone is perfect 100% of the time, Song said.

“Subjectively I feel a greater level of comfort and confidence whenever I have the femtosecond laser ‘tee up’ the cataract for me such that the capsulotomy is already completed, and the nucleus is already segmented before I’ve even entered the eye,” Song said.

Song said he uses the Catalys platform in his practice.

“I feel that the laser introduces a level of precision that is simply not attainable with the human hand and that it is a useful tool in the cataract surgeon’s armamentarium, particularly with denser cataracts and when performing astigmatic and/or presbyopic correction at the time of the surgery,” he said.

Learning curve

Additionally, the rates of unplanned vitrectomies were compared between early and later cases in order to assess the learning curve of the procedure. Thresholds were set at experience with the first 10, 20 and 50 cases compared with all subsequent cases, but there was no significant difference in the rate of unplanned vitrectomies, indicating that “this learning curve is short and readily surmountable,” the researchers said.

“Just to clarify, when we say a learning curve is steep, that means a high level of skill is achievable in a short amount of time and therefore relatively easy to acquire. A common misconception is that a skill with a steep learning curve is one that is difficult to achieve, akin to rolling a heavy boulder up a steep hill, when in fact it has the opposite meaning. So, the fact that there was no significant difference in the vitreous loss rates between early and late cases would be consistent with other published studies reporting that the learning curve is steep and short,” Song said. – Robert Linnehan

Disclosure: Song reports no relevant financial disclosures.