Femtosecond laser-assisted cataract surgery in eyes with shallow anterior chamber depth: comparison with conventional phacoemulsification.

PURPOSE To compare the postoperative outcomes between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification in eyes with shallow anterior chamber depth (ACD). SETTING Eye Clinic, NEUROFARBA Department, University of Florence, Italy. DESIGN Prospective case series. METHODS Forty eyes of 40 patients with senile cataract and true ACD < 2.00 mm underwent FLACS (femto group, n=20) or manual phacoemulsification (phaco group, n=20). Preoperatively and 1 week and 1 and 6 months after surgery central corneal thickness (CCT) and endothelial cell density were evaluated; basal epithelial cell (BEC) and Langerhans dendritic cell (LDC) densities and keratocyte activation were assessed using in-vivo corneal confocal microscopy. Intraoperative parameters such as cumulative dissipated energy (CDE) and ultrasound (US) power were recorded. RESULTS Endothelial cell loss was significantly lower in the femto group at all timepoints (p≤0.001). In the phaco group the CCT was significantly higher 1 week (p<0.001) and 1 month (p<0.001) after surgery than preoperatively; conversely, in the femto group it was higher only after 1 week (p<0.001). BECs and LDCs significantly increased 1 postoperative week (p<0.001), returning to preoperative values after 1 month in both groups. Keratocyte activation remained significantly higher 1 postoperative month only in the phaco group (p=0.005). CDE and US power were lower in the femto group (p=0.017 and p=0.001); they were correlated with ECL (r=0.662, p=0.000; r=0.389, p=0.013). CONCLUSIONS In eyes with shallow ACD, FLACS was a safe and effective technique, significantly reducing the postoperative endothelial cell loss and corneal inflammation compared to conventional phacoemulsification.