EyeWorld India March 2018 Issue

Cataract and Refractive Surgery (EUREQUO): Baseline characteristics, surgical procedure, and outcomes’ EWAP CATARACT/IOL March 2018 31 See Views from Asia-Paci c on page 33 impairment to inhibit reading and driving. The shift to operating on younger patients with better preop- erative acuity has been ascribed to, among other things, a diminishing population proportion of advanced cataracts and development of new- er technologies including FLACS, which give surgeons a perceived lower risk of complication. 7 Also demonstrating the relevance of patient selection in FLACS is the finding of this report that FLACS patients had fewer preoperative ocular comorbidities than other phacoemulsification cohorts (19.1% vs. 37.5%). 8 The authors speculate that surgeons may have been selective in recruit- ing patients with few preoperative comorbidities for FLACS due to hesitance to employ new technol- ogy in potentially risky cases. Interestingly, even with selection of patients with fewer preopera- tive ocular comorbidities, FLACS had a nontrivial postoperative complication rate. This was in spite of restricting inclusion to surgeons with at least 50 previous FLACS cases, which would limit any “learning curve” effect that could further increase the risk of complications. It was also in spite of having an average follow-up time of only 34 days, which would exclude late complications such as posterior capsule opacification and late endophthalmitis. The rate of FLACS postoperative complications thus deserves further investigation, as the authors acknowledge. This study further highlights the importance of patient selection in FLACS by reporting characteris- tics of patients receiving multifocal intraocular lenses. Approximately 40% of subjects received multifo- cal intraocular lenses. The most frequent recipients were patients with good preoperative visual acuity, as might be expected given current opinions on indications and contraindications for multifo- cal intraocular lens placement. 9 While FLACS provides a theoretic benefit for multifocal lens implan- tation by creation of a centered circular capsulorhexis, there has been no observed difference in postoperative visual acuity com- pared to manual phacoemulsifica- tion. 10 Although this study does not address financial considerations, the lack of clear superiority over manual phacoemulsification war- rants further examination of the cost–benefit ratio of FLACS. EWAP References 1. He L, et al. Femtosecond laser-assisted cataract surgery. Curr Opin Ophthalmol. 2011;22:43–52. 2. Abell RG, et al. Femtosecond laser- assisted cataract surgery compared with conventional cataract surgery. Clin Exp Ophthalmol. 2013;41:455–62. 3. Popovic M, et al. Efficacy and safety of femtosecond laser-assisted cataract surgery compared with manual cataract surgery: a meta-analysis of 14567 eyes. Ophthalmol. 2016;123:2113–26. 4. Ewe SY, et al. A comparative cohort study of visual outcomes in femtosecond laser- assisted versus phacoemulsification cata- ract surgery. Ophthalmol. 2016;123:178–82. 5. Lundström M, et al. Visual outcome of cataract surgery; study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg. 2013;39:673–9. 6. Abell RG, et al. Femtosecond laser- assisted cataract surgery versus standard phacoemulsification cataract surgery: outcomes and safety in more than 4000 cases at a single center. J Cataract Refract Surg. 2015;41: 47–52. 7. Lundström M, et al. The changing pattern of cataract surgery indications: a 5-year study of 2 cataract surgery data- bases. Ophthalmol. 2015;122:31–8. Femtosecond laser-assisted cataract surgeries (FLACS) reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO): baseline characteristics, surgical procedure, and outcomes Mats Lundström, MD, Mor Dickman, MD, Ype Henry, MD, Sonia Manning, MD, Paul Rosen, FRCS, Marie-José Tassignon, MD, David Young, PhD, Ulf Stenevi, MD J Cataract Refract Surg. 2017;43(12). Article in press. Purpose: To describe a large cohort of femtosecond laser-assisted cataract surgeries (FLACS) in terms of baseline characteristics and the related outcomes. Setting: Eighteen cataract surgery clinics in nine European countries and Australia. Design: Prospective multicenter cohort registry study. Methods: Data about consecutive eyes undergoing FLACS in the participating clinics were entered into the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). A specifically trained registry manager in each clinic was responsible for valid reporting to the EUREQUO. Data on demographics, preoperative corrected distance visual acuity (CDVA), risk factors, type of surgery, type of intraocular lens (IOL), visual outcome, refractive outcome, and complica- tions were reported. Results: Complete data were available for 3,379 cases. The mean age was 64.4 (±10.9) years, and 57.8% (95% CI 56.1–59.5) of the patients were female. A surgical complication was reported in 2.9% (95% CI 2.4–3.5) of all cases (2.2% FLACS-related like laser incision: 0.8% and laser capsulotomy 0.5 and in 0.7 ordinary phacoemulsificationrelated complicatio CDVA generally had the best visual and refractive outcome; patients with poor preoperative visual acuity had poorer outcomes. Conclusions: The visual and refractive outcomes of FLACS were favorable compared to manual phacoemulsification. The outcome was highly innuenced by the preoperative visual acuity, but all preoperative visual acuity groups showed an acceptable outcome. 8. Lundström M, et al. 1998 European Cataract Outcome Study: report from the European Cataract Outcome Study Group. J Cataract Refract Surg. 2001;27:1176–84. 9. Braga-Mele R, et al. Multifocal intraocular lenses: relative indications and contraindi- cations for implantation. J Cataract Refract Surg . 2014;40:313–22. 10. Lawless M, et al. Outcomes of femtosec- ond laser cataract surgery with a diffractive multifocal intraocular lens. J Refract Surg. 2012;28:859–64. Contact information Goshe: goshej@ccf.org