| Objectives: To evaluate the postoperative corneal endothelial cell loss and central corneal thickness(CCT)of patients with Fuchs’ endothelial corneal dystrophy(FECD)and senile cataract between conventional phacoemulsification surgery(Phaco)and femtosecond laser-assisted cataract surgery(FLACS).What’s more,in order to avoid unnecessary corneal endothelial transplantation,the article explored the best indications for patients with FECD undergoing FLACS and redefined the preoperative “safe-zone” of the CCT.In the end,in order to explore the necessity of Toric IOL and the best evaluation method of postoperative Toric IOL axial rotation in patients with high myopia and corneal astigmatism,this article main outcomes were the distant,middle and near visual acuity,near stereopsis,Toric IOL rotation stability.Methods: 1.A cohort study of 31 eyes of 18 cases were diagnosed a mild or moderate FECD(grade 2 to 4)and cataract undergoing FLACS or Phaco.The main outcomes were endothelial cell density(ECD),the rate of ECD loss,best corrected visual acuity,cumulative dissipated energy(CDE)and CCT.They were assessed preoperatively and 3 days,1 month,3,6 and 12 months postoperatively.2.A cohort study of 30 eyes of 23 cases were diagnosed a mild,moderate or severe FECD by Krachmer slit lamp classification undergoing FLACS.The main outcomes were ECD,CCT,peripheral corneal thickness at 4 mm from the center(PCT4mm)and peripheral corneal thickness at 3 mm from the center(PCT3mm).They were assessed preoperatively and 3 days,1 month,3 and 6 months postoperatively.3.A cohort study of 120 eyes of 60 cases were diagnosed high mpopia and cataract with corneal astigmatism undergoing cataract surgery.The patients were divided into three groups.40 eyes of 20 patients in Group A received FLACS and Toric IOL implantation.40 eyes of 20 patients in Group B1 received FLACS and IQ IOL implantation.40 eyes of 20 patients in Group A received Phaco and Toric IOL implantation.The main outcomes were corneal astigmatism,taget residual astigmatism,best corrected distant visual acuity,middle and near visual acuity,Toric IOL axial rotation,near stereopsis acuity,total high order aberration and total spherical aberration.They were assessed preoperatively and 7 days,1 month and 3 months postoperatively.Results: 1.In two groups,the difference in ECD was not statistically significant preoperatively and all follow-up examinations postoperatively(P>0.05).The mean CDE was significantly lower in the FLACS group(4.50±2.43)than in the Phaco group(7.17±2.80,P<0.05).The rate of ECD loss was significantly higher in the Phaco group than FLACS group,from 1 month to 12 months postoperatively(P<0.05).The mean CCT was significantly thicker in the Phaco group than in the FLACS group at 1,3 and 6 months postoperatively(both P<0.05).In both groups,the postoperative CCT at all follow-up visits was significantly greater than the preoperative CCT(both P<0.05).No bullous keratopathy or other intraoperative complications occurred in both groups during follow-up 12 months.2.The difference in ECD,PCT3 mm and PCT4 mm were statistically significant between mild and moderate FECD group,moderate and severe FECD group(both P<0.05).However,there was no significant difference in ECD,PCT3 mm and PCT4 mm between moderate and severe FECD group(P>0.05).In three groups,the difference in CCT was statistically significant preoperatively(P<0.05).There was the strongest correlation between preoperative CCT and FECD by Krachmer slit lamp classification.There was a significant correlation between PCT and age,and the more peripheral corneal thicknessm the greater agerelated trend.3.To avoid unnecessary corneal endothelial transplantation,Our data suggest that current cataract undergoing FLACS techniques allow for excellent visual rehabilitation in patients with FECD who have a preoperative corneal thickness of 640μm.4.The mean CDE was significantly lower in the FLACS group(5.43±2.52)than in the Phaco group(7.64±3.07,P<0.05)with high myopia and cataract patients.The ECD was significantly lower in the FLACS group than Phaco group(P<0.05).This suggested that FLACS has a lower surgical risk for high myopia.The mean CCT was significantly thicker in the Phaco group than in the FLACS group at 1,3 and 6 months postoperatively(both P<0.05). 5.The mean middle and near visual acuity,near stereopsis acuity and residual astigmatism was significantly better in the Group A than in the Group B1 at 7 day,1 and 3 months postoperatively(both P<0.05).And in two groups,the difference in best corrected distant visual acuity,total high order aberration and total spherical aberration were not statistically significant at all follow-up examinations postoperatively(P>0.05).6.In Group A and Group B2,the postoperative spherical equivalent,residual astigmatism and best corrected distant visual acuity at all follow-up visits was significantly lower than the preoperative data(P<0.05).The mean degree of rotation was significantly lower in the FLACS group(4.08°±2.25°)than in the Phaco group(5.95°±2.01°,P<0.05).30 eyes had less than 5° of rotation postoperatively and none eye had more than 10° of rotation in Group A.But in Group B2,20 eyes had less than 5° of rotation postoperatively and 1 eye had 12° of rotation.Conclusion: 1.FLACS have a a tendency to reduce CCT and achieve lower the rate of corneal endothelial cell loss than Phaco.It is an effective surgical method to reduce corneal endothelial decompensation in patients with FECD and cataract.2.In patients with FECD and cataract,the CCT after surgery remain thicker than preoperative,which suggest that the risk of corneal decompensation was higher in paitents with FECD.3.To avoid unnecessary corneal endothelial transplantation and redefine the preoperative “safe-zone” of the CCT,Our data suggest that current cataract undergoing FLACS techniques allow for excellent visual rehabilitation in patients with FECD who have a preoperative corneal thickness of 640μm.4.There have a strongest correlation between preoperative CCT and patients with FECD by Krachmer slit lamp classification.The preoperative CCT is a reproducible objective outcome for predicting the prognosis of FECD and surgical indications.5.The mean CDE and EPT were significantly lower in the FLACS group than in the Phaco group with high myopia and cataract patients.It is a safe and effective technique for patients with high myopia.6.Toric IOL not only improve the mean middle and near visual acuity,near stereopsis acuity and residual astigmatism in patients with high myopia and cataract,but also reduce the chance of wearing glasses.7.The capsular marks by Len SAR femtosecond laser system have more accuracy at Toric IOL axial rotation than traditional marks.It is a better evaluation method of postoperative Toric IOL axial rotation in patients with high myopia and corneal astigmatism. |
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