الفهرس | Only 14 pages are availabe for public view |
Abstract Cataract is characterized with opacity of the crystalline lens that can markedly limit the routine activities of patients such as reading, writing, walking and in the long run reduce the quality of life. Cataract is the main cause of preventable blindness. Despite some modern advances in the field of cataract impending drug treatments, surgical treatment is still known to be the most actual treatment option. Cataract surgery is the most frequently performed ophthalmic operation in the world. One of the most critical steps in cataract removal is creation of acontinuous round opening in the lens anterior capsule named capsulorhexis. CCC is considered to be the usual method of performing anterior capsulotomy. The size, shape and centration of capsulorhexis are key determinants of positioning IOL and eventually visual outcome. Too small or too large capsulorhexis can cause several problems, including IOL decentration, hyperopic shift, PCO , etc. CCC is a manual procedure and even with skilled surgeons the size, shape and centration of capsulorhexis can be variable depending on the type and maturity of the cataract. Femtosecond is the latest laser platform which has revolutionised cataract surgery by minimising surgeon dependent variations of capsulorhexis. Now we can modify the size, shape and centration of capsulorhexis depending upon type of intraocular lens and nuclear sclerosis. Femtosecond lasers (FSL) use as shorter pulse time as (10-15) seconds, thus further decreasing the energy output for a given effect without the collateral tissue damage. Therefore, FSL assisted surgery proved to be more precise and accurate in terms of producing predictable anterior capsulotomy that led to desired positioning of intra-ocular lens. There were certain reports that showed higher rate of anterior capsule tear with the use of FSL as compared with conventional CCC. The current study was performed to evaluate features of capsulotomies obtained during femtosecond laser–assisted cataract surgery (FLACS) and compare them with CCCs obtained using a standard manual technique and to determine whether FLACS is safer, effective and better or not. This meta-analysis was conducted from 1/1/2015 to 31/7/2018. Literature search on PubMed was done to identify randomised controlled trials and comparative studies MedCalc ver. 18.2 (MedCalc, Ostend, Belgium) was used for data analysis. Of the 17 articles included, there were 3(18%) randomised controlled trials and 14(82%) comparative study. The meta-analysis was based on a total of 18558 eyes. Of them, 9442 (50.88%) underwent femtosecond laser-assisted capsulotomy and 9116 (49.12%) underwent manual continuous curvilinear capsulorrhexis. Comparative study between the 2 groups revealed; highly significant increase in better IOL centration; in FLACS group; compared to CCC group; with highly significant statistical difference (p < 0.01). Comparative study between the 2 groups revealed nonsignificant difference as regards capsulotomy diameter (p > 0.05). Comparative study between the 2 groups revealed nonsignificant difference as regards CDVA, UDVA and MAE (p > 0.05) As regards the complications; fixed-effect model showed highly significant increase in complications rate in FLACS group; but random-effects model showed non-significant difference between the 2 groups (p < 0.001, p > 0.05 respectively). |