The effect comparision of femtosecond laser-assisted phacoemusification and microincision phacoemusification on ocular surface

Objective To compare the effects of femtosecond laser-assisted phacoemusification and microincision phacoemusification on ocular surface. Methods A nonrandomized comparative cohort study was designed.The study recruited 116 eyes of 116 patients with age-related cataract in Hankou Aier Eye Hospital from January to March 2018.Consecutive patients were divided into femtosecond laser-assisted phacoemulsification group (femtosecond laser group for short) (55 eyes) and microincision phacoemulsification group (microincision group for short) (61 eyes). The ocular surface disease index(OSDI), break-up time of tear film (BUT), corneal flurescein staining, Schirmer Ⅰ test (SⅠt) and goblet cell density were sequentially evaluated preoperatively and postoperatively at 1 week and 1 month.This study followed the Declaration of Helsinki.Written informed consent was obtained from each subject prior to entering study cohort.This study protocol was approved by Ethic Committee of Hankou Aier Eye Hospital (No.2017IRB01). Results At 1 day after surgery, the best corrected distance visual acuity (BCDVA) (LogMAR visual acuity) was 0.14(0.10, 0.24) and 0.20 (0.17, 0.27), respectively in the femtosecond laser group and the microincision group.BCDVA in the femtosecond laser group was better than that in the microincision group, with a significant difference between them(U=-3.140, P=0.002). Compared with the microincision group, the operation time was longer, the phaco time was shorter, the cumulative dissipated energy was lower, and the balanced salt solution perfusion volume was less in the femtosecond laser group, with significant differences between them (all at P<0.001). Compared with the pre-operation, the mean OSDI socres, BUT and goblet cell density were significantly decreased, and the fluorescein staining scores were significantly increased at 7 days and 30 days after surgery in the femtosecond laser group and the microincision group, with significant differences between them (all at P<0.05). The SⅠt value fluctuations in the two groups were small at different time points before and after operation, and the overall comparative differences between the two groups and different time points had no statistical significances (Fgroup=0.510, P=0.477; Ftime=0.741, P=0.479). Conclusions Compared with microincision phacoemusification, patients who had femtosecond laser-assisted phacoemusification have more severe ocular surface staining, shorter tear film time and more reduction of goblet cell count at the early stage. Key words: Cataract/surgery; Femtosecond laser/therapy use; Dry eye; Tear film; Microscopy, confocal; Goblet cells; Prospective study