Original Article 

Effects of Femtosecond Laser-Assisted Cataract Pretreatment on Pupil Diameter: A Comparison Between Three Laser Platforms

Vasilios F. Diakonis, MD, PhD; Nilufer Yesilirmak, MD; Ibrahim O. Sayed-Ahmed, MD; Daniel P. Warren, MSc; George A. Kounis, PhD; Zachary Davis, MS; Florence Cabot, MD; Sonia H. Yoo, MD; Kendall E. Donaldson, MD, MS

Abstract

PURPOSE:

To assess pupil diameter before and after femtosecond laser-assisted cataract surgery (FLACS) pretreatment and compare the outcomes of three laser platforms.

METHODS:

This prospective observational case series included consecutive patients scheduled to undergo cataract extraction using FLACS between August 2013 and February 2015. All eyes received FLACS pretreatment using three laser platforms: LenSx (Alcon Laboratories, Inc., Fort Worth, TX), Catalys (Abbott Medical Optics Inc., Santa Ana, CA), and Victus (Bausch & Lomb, Inc., Rochester, NY). The same protocol for preoperative medical mydriasis was used for all patients, and pupil diameter was assessed immediately before and 3 minutes after FLACS using a surgical ruler.

RESULTS:

A total of 198 eyes of 161 patients were included in the study. Mean pupillary miosis was 1.42 ± 1.26 mm for the LenSx, 0.66 ± 0.89 mm for the Catalys, and 0.14 ± 0.34 mm for the Victus groups. Furthermore, 8 of the 198 eyes (4.0%) demonstrated a pupil diameter of less than 5 mm after FLACS and 48 eyes (24.24%) demonstrated a pupil diameter of 6 mm or less. There was a statistically significant decrease in pupil diameter for all groups individually (P < .05). There was also a statistically significant difference among the three groups (P < .05), with LenSx inducing the highest degree of miosis, followed by Catalys, and finally Victus. A correlation between the pupil diameter before FLACS and degree of FLACS-induced miosis was demonstrated (P < .05), with larger pupil diameter before FLACS associated with greater miosis.

CONCLUSIONS:

FLACS pretreatment seems to induce significant pupillary miosis with all laser platforms assessed in this study. The decrease in pupil diameter after FLACS reached clinical significance for cataract extraction (< 5 mm) in 4.0% of cases, whereas 20.2% of eyes demonstrated small pupil diameter (≤ 6 mm) after FLACS pretreatment.

[J Refract Surg. 2016;32(2):84–88.]

Authors

From Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.

Dr. Yoo serves as a speaker and consultant for Alcon Laboratories, Inc. and Abbott Medical Optics, Inc. Dr. Diakonis received a scholarship (2014) from the Hellenic Society of Intraocular Implants and Refractive Surgery for fellowship training. The remaining authors have no financial or proprietary interest in the materials presented herein.

AUTHOR CONTRIBUTIONS

Study concept and design (VFD, SHY, TPO, KED); data collection (VFD, NY, IOS-A, DPW, ZD, FC, SHY); analysis and interpretation of data (VFD, GAK, SHY); writing the manuscript (VFD); critical revision of the manuscript (VFD, NY, IOS-A, DPW, GAK, ZD, FC, SHY, TPO, KED); statistical expertise (VFD, GAK); administrative, technical, or material support (DPW); supervision (SHY, TPO, KED)

Correspondence: Vasilios F. Diakonis, MD, PhD, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136. E-mail: diakonis@gmail.com

Received: June 09, 2015
Accepted: November 20, 2015

10.3928/1081597X-20151229-03

PURPOSE:

To assess pupil diameter before and after femtosecond laser-assisted cataract surgery (FLACS) pretreatment and compare the outcomes of three laser platforms.

METHODS:

This prospective observational case series included consecutive patients scheduled to undergo cataract extraction using FLACS between August 2013 and February 2015. All eyes received FLACS pretreatment using three laser platforms: LenSx (Alcon Laboratories, Inc., Fort Worth, TX), Catalys (Abbott Medical Optics Inc., Santa Ana, CA), and Victus (Bausch & Lomb, Inc., Rochester, NY). The same protocol for preoperative medical mydriasis was used for all patients, and pupil diameter was assessed immediately before and 3 minutes after FLACS using a surgical ruler.

RESULTS:

A total of 198 eyes of 161 patients were included in the study. Mean pupillary miosis was 1.42 ± 1.26 mm for the LenSx, 0.66 ± 0.89 mm for the Catalys, and 0.14 ± 0.34 mm for the Victus groups. Furthermore, 8 of the 198 eyes (4.0%) demonstrated a pupil diameter of less than 5 mm after FLACS and 48 eyes (24.24%) demonstrated a pupil diameter of 6 mm or less. There was a statistically significant decrease in pupil diameter for all groups individually (P < .05). There was also a statistically significant difference among the three groups (P < .05), with LenSx inducing the highest degree of miosis, followed by Catalys, and finally Victus. A correlation between the pupil diameter before FLACS and degree of FLACS-induced miosis was demonstrated (P < .05), with larger pupil diameter before FLACS associated with greater miosis.

CONCLUSIONS:

FLACS pretreatment seems to induce significant pupillary miosis with all laser platforms assessed in this study. The decrease in pupil diameter after FLACS reached clinical significance for cataract extraction (< 5 mm) in 4.0% of cases, whereas 20.2% of eyes demonstrated small pupil diameter (≤ 6 mm) after FLACS pretreatment.

[J Refract Surg. 2016;32(2):84–88.]

From Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.

Dr. Yoo serves as a speaker and consultant for Alcon Laboratories, Inc. and Abbott Medical Optics, Inc. Dr. Diakonis received a scholarship (2014) from the Hellenic Society of Intraocular Implants and Refractive Surgery for fellowship training. The remaining authors have no financial or proprietary interest in the materials presented herein.

AUTHOR CONTRIBUTIONS

Study concept and design (VFD, SHY, TPO, KED); data collection (VFD, NY, IOS-A, DPW, ZD, FC, SHY); analysis and interpretation of data (VFD, GAK, SHY); writing the manuscript (VFD); critical revision of the manuscript (VFD, NY, IOS-A, DPW, GAK, ZD, FC, SHY, TPO, KED); statistical expertise (VFD, GAK); administrative, technical, or material support (DPW); supervision (SHY, TPO, KED)

Correspondence: Vasilios F. Diakonis, MD, PhD, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136. E-mail: diakonis@gmail.com

Received: June 09, 2015
Accepted: November 20, 2015
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