Management of Severely Subluxated Cataracts Using Femtosecond Laser-Assisted Cataract Surgery.
OBJECTIVE
To assess the role of femtosecond laser technology in the management of severely subluxated cataracts.


METHODS
Retrospective, interventional case series.


METHODS
All eyes with subluxated cataract seen between July 2012 and June 2015 were assessed for suitability for femtosecond laser-assisted cataract surgery, with the use of capsular tension devices. Participants with subluxated cataracts of at least 6 clock hours of zonular weakness were included in the study. Data collected included patient demographics, preoperative and postoperative best-corrected visual acuity (BCVA), nuclear density, extent of zonular weakness, completeness of capsulotomy, and complications. Poor visual outcome was defined as BCVA of worse than 20/40. Main outcome measure was the retention of the capsular bag.


RESULTS
Of the 72 eyes with subluxated cataracts undergoing surgery during the study period, 47 eyes of 47 patients were eligible for analysis. Mean age of the patients was 60.7 years (standard deviation [SD] 13.2 years). The majority were male (32, 68.1%) and Chinese (38, 80.8%). The mean duration of follow-up was 8 months (SD 5.6 months). The main identifiable cause of lens subluxation was trauma (11 eyes). Almost two thirds (30 eyes) had more than 9 clock hours of zonular weakness. Seventy percent of cataracts (33) were nuclear sclerosis grade 3 and above. The capsular bag was preserved in 43 eyes (91.5%). The intraocular lens was stable and centered at the last follow-up in all these 43 eyes. An anterior capsule tear occurred in 6 eyes, all of which had cataracts of nuclear sclerosis grade 3 and above, with posterior extension occurring in 3 eyes. Primary posterior capsule rupture occurred in 1 eye. At 1 month 37 eyes (80.4%) had a BCVA of 20/40 or better. There was significant improvement in BCVA at 1 month (mean of 0.92 logMAR units [SD 0.88] to 0.22 [SD 0.38] [P < .001, paired samples t test]), which was maintained at 1 year.


CONCLUSIONS
Selected cases of severely subluxated cataracts may be managed using femtosecond laser technology to perform the capsulotomy and nuclear fragmentation, with successful preservation of the capsular bag in 90% of eligible cases, especially in eyes with soft cataracts.
Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore; Duke-National University of Singapore Graduate Medical School, Singapore. Electronic address: chee.soon.phaik@singhealth.com.sg.
Soon-Phaik
SP
Chee
Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Duke-National University of Singapore Graduate Medical School, Singapore.
Melissa H Y
MH
Wong
Singapore National Eye Centre, Singapore; Division of Ophthalmology, Changi General Hospital, Singapore.
Aliza
A
Jap
D000368:Aged; D002386:Cataract / Q000150:complications* / Q000175:diagnosis; D002387:Cataract Extraction / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D007903:Lens Capsule, Crystalline / Q000601:surgery*; D007906:Lens Subluxation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007908:Lens, Crystalline / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity