Ultrasound energy consumption and macular changes with manual and femtolaser‐assisted high‐fluidics cataract surgery: a prospective randomized comparison

PURPOSE: The purpose of the study was to compare ultrasound (US) consumption and central macular thickness (CMT) and volume changes with manual and femtosecond laser (FSL)‐assisted cataract nucleus workup. METHODS: Sixty patients scheduled for immediate sequential bilateral surgery underwent a prospective randomized intraindividual comparison of nucleus sector fragmentation performed manually in one eye and with low‐energy FSL assistance in the partner eye, followed by high‐fluidics phacoaspiration with a maximum US power of 30%. Ultrasound (US) energy consumption and macular thickness and volume were compared as measured by intraoperative effective phacoemulsification time (EPT) and high‐resolution spectral domain optical coherence tomography pre‐ and 1 week, 3 weeks and 6 weeks postoperatively. Results are presented as means ± SD or medians [min; max]. RESULTS: Fifty‐two patients completed the full follow‐up. For the manual and FSL‐assisted groups, nuclear hardness was almost identical with a mean LOCS III grade of 2.44 ± 1.08 and 2.50 ± 1.00 (p = 0.371). Median EPT was 1.40 [0.2; 8.3] and 1.25 [0.2; 9.4] seconds. Median preoperative CMT was 276.50 [263.25; 289.75] µm and 276.00 [262.00; 290.00] µm. Median postoperative CMT was 278.00 [260.50; 288.00] versus 275.50 [264.00; 290.50] µm at 1 week, 279.50 [266.75; 292.25] versus 280.00 [266.50; 294.50] µm at 3 weeks and 280.50 [268.00, 293.75] versus 279.50 [264.75; 295.25] µm at 6 weeks. Differences in CMT and total macular volume between the groups were not statistically significant at any point in time. CONCLUSION: Femtosecond laser (FSL) prefragmentation of the nucleus into six sectors did not reduce US energy consumption compared with manual splitting of the nucleus into four quadrants in this particular surgical setting. Sectorial FSL‐prechopping with the low‐energy FSL used had no additional impact on postoperative macular thickness and volume.