Evaluation of the Clinical Efficacy of Full Femtosecond Laser Surgery in the Treatment of Myopia

Objective:To evaluate the clinical effect of full femtosecond laser surgery in the treatment of myopia patients.Methods:120 myopia patients admitted to our hospital from January 2022 to June 2023 were selected.According to the random number table method,60 patients in the observation group underwent full femtosecond laser surgery,and 60 patients in the control group underwent femtosecond laser-assisted in situ keratomileusis(FS-LASIK)surgery.The clinical effects of the two groups were compared.Results:10 days postoperatively and 6 months after operation,the visual acuity level of the observation group was higher than that of the control group,the postoperative corneal asphericity coefficient and corneal full-thickness were lower than those of the control group,and the total effective rate 6 months after operation was higher than that of the control group(P<0.05).Conclusion:Full femtosecond laser surgical treatment can improve the postoperative visual acuity of patients with myopia,enhance the corneal asphericity coefficient(Q)and corneal full-thickness,and exert significant clinical effects.

Corneal astigmatic outcomes after femtosecond laser-assisted cataract surgery combined with surface penetrating arcuate keratotomies

AIM:To evaluate corneal astigmatic outcomes of femtosecond laser-assisted arcuate keratotomies(FAKs)combined with femtosecond-laser assisted cataract surgery(FLACS)over 12mo follow-up.METHODS:Totally 145 patients with bilateral cataracts and no ocular co-morbidities were recruited to a singlecentre,single-masked,prospective randomized controlled trial(RCT)comparing two monofocal hydrophobic acrylic intraocular lenses.Eyes with corneal astigmatism(CA)of>0.8 dioptres(D)received unpaired,unopened,surface penetrating FAKs at the time of FLACS.Visual acuity,subjective refraction and Scheimpflug tomography were recorded at 1,6,and 12mo.Alpins vectoral analyses were performed.RESULTS:Fifty-one patients(61 eyes),mean age 68.2±9.6y[standard deviation(SD)],received FAKs.Sixty eyes were available for analysis,except at 12mo when 59 attended.There were no complications due to FAKs.Mean pre-operative CA was 1.13±0.20 D.There was a reduction of astigmatism at all post-operative visits(residual CA 1mo:0.85±0.42 D,P=0.0001;6mo:0.86±0.35 D,P=0001;and 12mo:0.90±0.39,P=0.0001).Alpins indices remained stable over 12mo.Overall,the cohort was under-corrected at all time points.At 12mo,61%of eyes were within±15 degrees of pre-operative astigmatic meridian.CONCLUSION:Unpaired unopened penetrating FAKs combined with on-axis phacoemulsification are safe but minimally effective.CA is largely under-corrected in this cohort using an existing unmodified nomogram.The effect of arcuate keratotomies on CA remained stable over 12mo.

Selective laser trabeculoplasty as adjunctive treatment for open-angle glaucoma vs following incisional glaucoma surgery in Chinese eyes

BACKGROUND Selective laser trabeculoplasty(SLT)is a relatively safe and effective therapy in lowering intraocular pressures(IOP)for glaucoma.AIM To study the long-term effects of SLT on IOP and number of glaucoma medications used in Chinese eyes.METHODS This is a retrospective study in which 75 eyes of 70 patients with open-angle glaucoma(OAG,n=36)and eyes with prior glaucoma surgery(PGS,n=39)were included.Changes in mean IOP and number of glaucoma medications used evaluated at 1 d,1 wk,1 mo,3 mo,6 mo,12 mo,and 36 mo after laser treatment.RESULTS All patients(33 male,37 female)were Chinese.The mean age was 44.34±16.14years.Mean pre-SLT IOP was 22.75±2.08 mmHg in OAG and 22.52±2.62 mmHg in PGS.Mean IOP was significantly reduced 1 d,1 wk,1 mo and 3 mo after laser treatment(P<0.05,respectively).Whereas,there were no significant differences between baseline and SLT treated groups at the 6th month both in OAG(P=0.347,P>0.05)and in PGS(P=0.309,P>0.05).Six months after SLT treatment,some patients received retreatment of SLT or were given more topical IOP-lowering medication to control the IOP.By the end of our study,the average IOP decreased to 20.73±1.82 mmHg in OAG and 20.49±1.53 mmHg in PGS groups.The number of glaucoma medications used was significantly reduced until the end of 3 years compared to baseline.CONCLUSION SLT could reduce IOP as adjunctive treatment both in OAG and PGS groups.SLT significantly reduced the number of glaucoma medications used 3-years following treatment in glaucoma patients.

Endovenous laser treatment vs conventional surgery for great saphenous vein varicosities: A propensity score matching analysis

BACKGROUND Varicosis is a common venous condition,which is typically treated surgically.However,selection of the optimal surgical approach can be challenging.Previous studies comparing endovenous laser treatment(EVLT)and conventional surgery were retrospective and observational in nature and the results may therefore have been influenced by selection bias and the presence of other confounding factors.In this study,we used propensity score matching to reduce selection bias when comparing EVLT and conventional surgery for the treatment of varicose great saphenous veins.METHODS We retrospectively reviewed the records of 1063 patients treated for primary varicosis of the great saphenous vein at the Second Affiliated Hospital of Xuzhou Medical University between January 2009 and December 2019.Among them,56 patients were excluded owing to additional small saphenous varicose vein involvement,81 owing to recurring varicose veins,83 owing to complicated varicose veins(CEAP clinical classification C5-C6),and 6 owing to perioperative phlebitis.Finally,772 patients were enrolled in this study.Standard demographic and clinicopathological data were collected from the medical records of the patients.For propensity score matching,522 patients(261 who underwent EVLT and 261 who underwent conventional surgery)were randomly matched 1:1 by age,sex,onset time,smoking status,presence of diabetes,family history,stress therapy,C class,and the affected leg.RESULTS Of the 772 patients included in the study,467 underwent EVLT and 305 underwent conventional surgery.There were significant differences in age,onset time,smoking and diabetes status,and family history between the two groups.Following propensity score matching,no significant differences in patients’characteristics remained between the two groups.ELVT was associated with a shorter operation time and hospital stay than conventional surgery,both before and after propensity score matching.There were no differences in complications between the two groups after propensity score matching.Patients who underwent EVLT had a higher recurrence rate during the two-year follow-up period than those who underwent conventional surgery(33.33%vs 21.46%,χ^(2)=11.506,P=0.001),and a greater percentage of patients who underwent EVLT experienced pain one week after the procedure(39.85%vs 19.54%,P=0.000).CONCLUSION EVLT may not always be the best option for the treatment of great saphenous vein varicosis.

Comparison of visual performance with iTrace analyzer following femtosecond laser-assisted cataract surgery with bilateral implantation of two different trifocal intraocular lenses

AIM:To compare the postoperative binocular visual performance with an iTrace analyzer following femtosecond laser-assisted cataract surgery(FLACS)combined with bilateral implantation of two different types of diffractive trifocal intraocular lenses(IOL).METHODS:During this retrospective observational study,patients who received bilateral FLACS combined with implantation of two different types of diffractive trifocal IOLs were evaluated.According to the IOLs’different types and design,the patients were divided into AT LISA tri839MP group(tri839 group)and AcrySof PanOptix TFNT00 group(TFNT group).Study parameters included preoperative and postoperative uncorrected distance visual acuity(UDVA)at 5 m,uncorrected near visual acuity(UNVA)at 30 cm and 40 cm,uncorrected intermediate visual acuity(UIVA)at 60 cm and 80 cm,postoperative refractive status,objective visual qualities and total high order aberrations(HOAs)postoperatively.The postoperative complications were also recorded.RESULTS:Totally 56 eyes of 28 patients(tri839 group,n=26;TFNT group,n=30)were included.Preoperative baseline characteristics between groups were not statistically significantly different.UDVA was not significantly different between groups except for 1wk follow-up due to the postoperative corneal edema.TFNT group showed statistically significant better UNIA at 60 cm than tri839 group at the 1wk(0.05±0.19 vs 0.15±0.10 logMAR,P=0.013),1mo(0.05±0.12 vs 0.15±0.09 logMAR,P=0.001)and 3mo(0.04±0.12 vs 0.15±0.11 logMAR,P=0.001)follow-up,while tri839 group showed statistically significant better UNIA at 80 cm than TFNT group at the 1d(0.14±0.15 vs 0.20±0.14 logMAR,P=0.041)and 1mo(0.09±0.07 vs 0.14±0.10 logMAR,P=0.042)follow-up.Postoperative refractive status showed stable at every visit.Modulated transfer function(MTF)values and strehl ratio(SR)values were improved and HOAs were lower significantly after surgery.CONCLUSION:FLACS with bilateral implantations of both tri839 and TFNT00 can achieve satisfactory natural whole-course vision,high postoperative refractive stability and good visual quality but without significantly difference.iTrace aberration instrument can accurately evaluate the visual quality under different status.

Comparing the intraoperative complication rate of femtosecond laser-assisted cataract surgery to traditional phacoemulsification

AIM: To compare the complication rate of femtosecond laser-assisted cataract surgery(FLACS) and traditional phacoemulsification for the first 18 mo of FLACS use at a private surgical center in Hawaii.METHODS: A retrospective chart review was conducted from January 2012 to June 2013. The first 273 consecutive eyes receiving FLACS and 553 eyes receiving traditional phacoemulsification were examined.All surgeries were performed at a single surgical center in Hawaii. The presence of intraoperative complications was used as the main outcome measure. Approval was obtained from the institutional review board of the University of Hawaii.RESULTS: The overall complication rate for FLACS was 1.8%, while that of the traditional procedure was5.8%(P 【0.05). A majority of the surgeons(80%) had a lower complication rate while using FLACS.CONCLUSION: FLACS is comparable in safety, if not safer, than traditional cataract surgery when performed by qualified cataract surgeons on carefully selected patients.

Case report:simultaneous femtosecond laser astigmatic keratotomy and toric intraocular lens implantation in femtosecond laser-assisted cataract surgery in a patient with surgically induced high corneal astigmatism

Background:Femtosecond laser astigmatic keratotomy(FSAK)and toric intraocular lens(IOL)implantation have been studied individually for comparison to treat astigmatism at cataract surgery.We report a case of surgically induced high corneal astigmatism by laser thermal keratoplasty(LTK)in a patient with cataract who was successfully treated with simultaneous combination of FSAK and toric IOL implantation with femtosecond laser-assisted cataract surgery(FLACS).This is the first report of both procedures combined simultaneously,with or without history of LTK.Case Description:A 68-year-old male presented with a history of LTK with two enhancements each eye in 2004,with subsequent surgically induced high corneal astigmatism,and with age-related nuclear cataract of both eyes.IOL master demonstrated+7.71 diopters of astigmatism at 163 degree right eye and+3.29 diopters of astigmatism at 4 degree left eye.After extensive discussion of the risks and benefits,the patient agreed to undergo FLACS with FSAK with two 61 degrees of relaxation incisions(RIs)and toric IOL(Alcon SN6AT9)right eye;FLACS with toric IOL(Alcon SN6AT7)alone left eye.At 2-year follow-up,uncorrected visual acuity was 20/30 right eye,20/25 left eye.His best corrected visual acuity was 20/25(+0.25+1.00 axis 21)right eye and 20/20(plano+0.25 axis 90)left eye;his best corrected near visual acuity was J1+with add+2.50 diopters right eye and left eye.Conclusions:Patients with age-related cataract and LTK induced high corneal astigmatism can hardly be sufficiently treated with FSAK or toric IOL alone at the time of cataract surgery.An effective way is to combine large FSAK and toric IOL of the highest cylindrical power of T9,in our case,simultaneously,which can achieve an excellent long term visual outcome.

Corneal neuromediator profiles following laser refractive surgery

Laser refractive surgery is one of the most commonly performed procedures worldwide.In laser refractive surgery,Femtosecond Laser in Situ Keratomileusis and Refractive Lenticule Extraction have emerged as promising alternatives to microkeratome Laser in Situ Keratomileusis and Photorefractive Keratectomy.Following laser refractive surgery,the corneal nerves,epithelial and stromal cells release neuromediators,including neurotrophins,neuropeptides and neurotransmitters.Notably,nerve growth factor,substance P,calcitonin gene-related peptide and various cytokines are important mediators of neurogenic inflammation and corneal nerve regeneration.Alterations in neuromediator profiles and ocular surface parameters following laser refractive surgery are attributed to the surgical techniques and the severity of tissue insult induced.In this review,we will discuss the(1)Functions of neuromediators and their physiological and clinical significance;(2)Changes in the neuromediators following various laser refractive surgeries;(3)Correlation between neuromediators,ocular surface health and corneal nerve status;and(4)Future directions,including the use of neuromediators as potential biomarkers for ocular surface health following laser refractive surgery,and as adjuncts to aid in corneal regeneration after laser refractive surgery.

Comparison of perioperative parameters in one-handed rotational phacoemulsification versus conventional phacoemulsification and femtosecond laser-assisted cataract surgery

AIM:To compare perioperative parameters of one-handed rotational phacoemulsification technique(one-handed phaco-roll)with each of other two techniques,“Divide et Conquer”and femtosecond laser-assisted cataract surgery(FLACS)METHODS:In this retrospective and comparative cohort study,eyes with uncomplicated cataract(nuclear density grade 2 to 3)treated routinely with one-handed phacoroll(n=23;Group 1)or“Divide et Conquer”(n=23;Group 2)or FLACS(n=23;Group 3)were enrolled.Intraoperative parameters including effective phaco-time(EPt),ultrasound time(USt),aspiration time,surgical time,phacoemulsification(phaco)-power,balanced salt solution(BSS)use,cumulative dissipated energy(CDE)were recorded and compared.Clinical outcomes including best corrected visual acuity(BCVA),corneal endothelial cell density(ECD),endothelial cell loss(ECL),central corneal thickness(CCT)and central macular thickness(CMT),were assessed and compared pre-operatively and at 1mo after surgery.RESULTS:Aspiration and surgical time,and BSS used were lower in Group 1(P<0.01)than other groups.EPt,phaco-power and CDE were lower in Group 1(P<0.05)than Group 2 but not significantly different from Group 3.In Group 1,USt was lower(P<0.05)than Group 2 but higher(P<0.05)than Group 3.BCVA improved in all groups without significant difference between Group 1 and the other ones.No significant differences regarding all post-operative morphologic outcomes(ECD,ECL,CCT,CMT)were reported.No clinical complications occurred.CONCLUSION:One-handed phaco-roll seems to be less time-consuming than“Divide et Conquer”and FLACS and less energy-consuming than“Divide et Conquer”.Furthermore,one-handed phaco-roll seems to have an equal safety profile compared to the other two techniques.

LIMITATIONS OF CANCER MARGIN DELINEATION BY MEANS OF AUTOFLUORESCENCE IMAGING UNDER CONDITIONS OF LASER SURGERY

Limitations of cancer margin delineation and surgical guidance by means of autofluorescence imaging under conditions of laser ablation were investigated and preliminary results are presented.PinPoint^(TM)(Novadaq Technologies Inc.,Canada)was used to capture digital images and Er:YAG laser(2.94μm,Glissando,WaveLight^(TM),Germany)was exploited to cause laser ablation on both normal and cancer sites of the specimen.It was shown that changes of the autofluorescence image after ablation extend beyond the actual sizes of the ablation loci.The tumor tissue after the laser ablation starts to emit fluorescent light within the green wavelength band(490-550nm)similar to normal tissue stating that the current technology of in-process tissue classification fails.However,when the autofluorescence was collected in the red range(600-750nm),then the abnormal/normal contrast was reduced,but still present even after the laser ablation.The present study highlights the importance of finding a proper technology for surgical navigation of cancer removal under conditions of high power effects in biological tissues.

Comparison of complication rates between femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery

Dear Editor,We read with interest the Meta-analysis conducted by Chen et al[1]on the clinical outcomes and complication rates between femtosecond laser-assisted cataract surgery(FLACS)and conventional phacoemulsification cataract surgery(CPCS).The authors reported no statistical difference between both methods for all measured complications except posterior capsular tear,with CPCS displaying a higher rate of posterior capsular tear.Since its inception in 2011[2].

Indocyanine green:The guide to safer and more effective surgery

In this editorial we comment on the article by Kalayarasan and co-workers published in the recent issue of the World Journal of Gastrointestinal Surgery.The authors present an interesting review on the use of indocyanine green fluo-rescence in different aspects of abdominal surgery.They also highlight future perspectives of the use of indocyanine green in mini-invasive surgery.Indo-cyanine green,used for fluorescence imaging,has been approved by the Food and Drug Administration and is safe for use in humans.It can be administered in-travenously or intra-arterially.Since its advent,there have been several advance-ments in the applications of indocyanine green,especially in the surgical field,such as intraoperative mapping and biopsy of sentinel lymph node,measurement of hepatic function prior to resection,in neurosurgical cases to detect vascular anomalies,in cardiovascular cases for patency and assessment of vascular ab-normalities,in predicting healing following amputations,in helping visualization of hepatobiliary anatomy and blood vessels,in reconstructive surgery,to assess flap viability and for the evaluation of tissue perfusion following major trauma and burns.For these reasons,the intraoperative use of indocyanine green has become common in a variety of surgical specialties and transplant surgery.Co-lorectal surgery has just lately begun to adopt this technique,particularly for perfusion visualization to prevent anastomotic leakage.The regular use of in-docyanine green coupled with fluorescence angiography has recently been pro-posed as a feasible tool to help improve patient outcomes.Using the best available data,it has been shown that routine use of indocyanine green in colorectal surgery reduces the rates of anastomotic leak.The use of indocyanine green is proven to be safe,feasible,and effective in both elective and emergency scenarios.However,additional robust evidence from larger-scale,high-quality studies is essential before incorporating indocyanine green guided surgery into standard practice.

Human lens epithelial cell apoptosis and epithelial to mesenchymal transition in femtosecond laser-assisted cataract surgery

AIM： To evaluate human lens epithelium cell apoptosis and epithelial to mesenchymal transition （EMT） induced by femtosecond laser in femtosecond laser assisted cataract surgery （FLACS）. METHODS： Sixty cataract patients with N2 to N3 stage according to the LOCS III were enrolled in this study and divided into three groups randomly： FLACSl group （cataract surgery by FLACS with LenSx）, FLACS2 group （cataract surgery by FLACS with LensAR） and manual group （cataract surgery by phacoemulsification）. Patients in two FLACS groups performed anterior capsulotomy by LenSx or LensAR laser system. Patients in the manual group were performed continuous curvilinear capsulorrhexis （CCC） manually. The anterior capsules were fixed right after moved out of eye. Hematoxylin-eosine staining, immunofluorescence staining and real-time PCR were performed in order to observe human lens epithelium cells changes after cataract surgery. RESULTS： The capsule cutting edge was shown irregularity and roughness in two FLACS groups and smooth edge in manual capsulotomy by pathologic staining. Irregularities of the cell configuration with partly swollen and destroyed nuclei were observed in two FLACS groups. Femtosecond laser could induce a significantly higher cell apoptosis in human lens epithelium cell than manually performed CCC （P〈0.05）. Lens epithelium cells apoptosis were correlated with femtosecond laser duration according to Pearson correlation analysis. Decreased N-cadherin expression, alpha-SMA and FSP-1 level in two FLACS groups showed the inhibition of cell EMT. CONCLUSION： Femtosecond laser may affect the apoptosis and EMT of lens epithelium cells which are under the peeled central lens capsule.

Comparative clinical outcomes of Tecnis toric IOL implantation in femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery

AIM: To compare the short-term visual outcomes, residual refractive cylinder, and rotation stability after Tecnis toric intraocular lens(IOL) implantation during femtosecond laserassisted cataract surgery(Femto phaco) and conventional phacoemulsification surgery(Conventional phaco).METHODS: In a prospective cohort study, Conventional phaco and Femto phaco(anterior capsulotomy and lens fragmentation by a femtosecond laser) with Tecnis toric IOL implantation were performed in 40 eyes from 36 patients and 37 eyes from 33 patients, respectively. The uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), and manifest refraction were assessed during 1 d, 1 wk, and 1 mo follow-ups. The orientation of the Tecnis Toric IOL was evaluated during 1 wk and 1 mo follow-ups.RESULTS: There were no significant differences in UDCA or CDVA between two groups at 1 mo postoperatively, though relatively more subjects had UDVA values of 20/25 or better in Femto phaco group than in the Conventional group(P>0.05). A lower but not significantly lower rate of having more than 5° of IOL rotation was observed in Femto phaco group at the 1-month follow-up, while a significant lower rate of residual astigmatism of ≤1 D was observed in Femto phaco group.CONCLUSION: The Femto phaco group has significantly more subjects with the residual astigmatism of ≤1 D, but there are no significant differences in rotation stability and visual outcomes as compared with the Conventional phaco group after the application of the Tecnis toric IOL in this cohort.

Effect of femtosecond laser-assisted steepest-meridian clear corneal incisions on preexisting corneal regular astigmatism at the time of cataract surgery

AIM:To investigate the clinical efficacy and safety of femtosecond laser-assisted steepest-meridian clear corneal incisions for correcting preexisting corneal astigmatism performed at the time of cataract surgery.METHODS:This prospective case series study comprised consecutive age-related cataract patients with corneal regular astigmatism(range:+0.75 to+2.50 D)who had femtosecond laser-assisted steepest-meridian clear corneal incisions(single or paired).Corneal astigmatism was performed with the Pentacam preoperatively and 3 mo postoperatively.Total corneal astigmatism and steepestmeridian measured in the 3-mm central zone were used to guide the location,size and number of clear corneal incision.The vector analysis of astigmatic change was performed using the Alpins method.RESULTS:Totally 138 eyes of 138 patients were included.The mean preoperative corneal astigmatism was 1.31±0.41 D,and was significantly reduced to 0.69±0.34 D(equivalent to difference vector)after surgery(P<0.01).The surgically-induced astigmatism was 1.02±0.54 D.The correction index(ratio of target induced astigmatism and surgically-induced astigmatism:0.72±0.36)as well as the magnitude of error(difference between surgically-induced astigmatism and target induced astigmatism:-0.29±0.51)represented a slight under correction.For angle of error,the arithmetic mean was 1.11±13.70,indicating no significant systematic alignment errors.CONCLUSION:Femtosecond-assisted steepest-meridian clear corneal incision is a fast,customizable,adjustable,precise,and safe technique for the reduction of low to moderate corneal astigmatism during cataract surgery.

Comparing corneal outcome between femtosecond laser-assisted cataract surgery and conventional phaco surgery in Fuchs’endothelial dystrophy patients:a randomized pilot study with 6mo follow up

AIM:To compare the corneal outcome in Fuchs’endothelial dystrophy(FED)patients between femtosecond laser-assisted cataract surgery(FLACS)and conventional phaco surgery(CPS).METHODS:This was a randomized controlled study comparing one eye surgery by FLACS and the contralateral eye operated by CPS(stop and chop technique)in FED patients.Central corneal thickness,corneal light backscatter,corneal densitometry,and central corneal endothelial cell count and hexagonality(noncontact endothelial cell microscope),and corrected distance visual acuity(CDVA)were assessed preoperatively and at day 1,40,and 180 postoperatively.RESULTS:Totally 31 patients(16 women)were included.At day 40 postoperatively,the mean endothelial cell loss(ECL)was 23.67%by FLACS and 17.30%by CPS(P=0.53).At day 180 postoperatively,ECL was 25.58%in FLACS and 21.32%in CPS(P=0.69).Densitometry data in all layers and all annuli from anterior layer to posterior layer in annuli 0-2,2-6,6-10 and 10-12,total densitometry with all layers and all annuli was performed.A significant difference was found in 6-10(posterior layer)at day 1 with-1.42 grayscale units(GSU;95%CI:-2.66 to-0.19,P=0.02).In 10-12(anterior layer,central layer and all layers)at day 40 were significant different with 7.7(95%CI:1.89 to 13.50,P=0.009),3.97(95%CI:0.23 to 7.71,P=0.03),4.73 GSU(95%CI:0.71 to 8.75,P=0.02),respectively.In the remaining parameters we found no difference between the two groups(P>0.05).Three CPS eyes suffered from corneal decompensation.CONCLUSION:There is no significant difference in corneal outcome between FLACS and CPS.Endothelial cell density and pentacam corneal outcome may be inadequate as outcome parameters in FED patients.

Profitability analysis of a femtosecond laser system for cataract surgery using a fuzzy logic approach

AIM：To define the financial and management conditions required to introduce a femtosecond laser system for cataract surgery in a clinic using a fuzzy logic approach.METHODS：In the simulation performed in the current study,the costs associated to the acquisition and use of a commercially available femtosecond laser platform for cataract surgery（VICTUS,TECHNOLAS Perfect Vision GmbH,Bausch ＆ Lomb,Munich,Germany） during a period of 5y were considered.A sensitivity analysis was performed considering such costs and the countable amortization of the system during this 5y period.Furthermore,a fuzzy logic analysis was used to obtain an estimation of the money income associated to each femtosecond laser-assisted cataract surgery（G）. RESULTS：According to the sensitivity analysis,the femtosecond laser system under evaluation can be profitable if 1400 cataract surgeries are performed per year and if each surgery can be invoiced more than $500.In contrast,the fuzzy logic analysis confirmed that the patient had to pay more per surgery,between $661.8 and $667.4 per surgery,without considering the cost of the intraocular lens（IOL）.CONCLUSION：A profitability of femtosecond laser systems for cataract surgery can be obtained after a detailed financial analysis,especially in those centers with large volumes of patients.The cost of the surgery for patients should be adapted to the real flow of patients with the ability of paying a reasonable range of cost.

Femtosecond laser corneal refractive surgery for the correction of high myopic anisometropic amblyopia in juveniles

AIM： To evaluate the effects of femtosecond laser-assisted in situ keratomileusis（FS-LASIK） and small-incision lenticule extraction（SMILE） to correct high myopic anisometropic amblyopia in juvenile patients. METHODS： From November 2013 to January 2015, 33 amblyopic patients with high myopic anisometropic amblyopia were studied. FS-LASIK（30 eyes） or SMILE（3 eyes） was performed in the amblyopic eyes. Visual acuity, refraction, contrast sensitivity, stereoacuity and complications were evaluated. Patients completed followup examinations at 3 d, 1 mo, 3 mo and the last follow-up time（mean 8.17±3.23 mo） after surgery. RESULTS： The mean age at surgery was 9.04±3.04 y（range 6-16 y）. The mean spherical equivalent in the amblyopic eyes was significantly decreased from-10.00±2.39 D preoperatively to-0.06±1.06 D at 1 mo,-0.19±1.33 D at 3 mo and-0.60±1.43 D at approximately 8 mo postoperatively（P〈0.05 for all）. The mean myopic anisometropia was significantly decreased from-9.45±2.33 D preoperatively to ＋0.37±1.48 D at 1 mo,-0.46±1.47 D at 3 mo and-0.09±1.83 D at approximately 8 mo（P〈0.05 for all）. The logarithm of the minimum angle of resolution（log MAR） for uncorrected and corrected distance visual acuity（UDVA and CDVA, respectively） of the amblyopic eye improved from 1.74±0.35 and 0.98±0.63 preoperatively to 0.45±0.31 and 0.41±0.33 at approximately 8 mo after surgery, respectively. The logM AR CDVA at 3 d, 1, 3 and 8 mo postoperatively improved by means of 1.42, 2.22, 2.96, and 4.39 lines, and a gain of more than two lines accounted for 45%, 50%, 74% and 86% of all patients, respectively. The contrast sensitivity of both amblyopic eyes and dominant eyes at 0.5, 2, 8 cycles perdegree was significantly improved postoperatively（P〈0.05 for all）. Of the 33 pediatric patients, no patients had near stereopsis preoperatively and seven patients（21.2%） recovered near stereopsis（400″ to 60″） at approximately 8 mo after surgery. No intraoperative or postoperative complications occurred in any patient.CONCLUSION： FS-LASIK or SMILE can be promising alternative methods to correct high myopic anisometropic amblyopia in juvenile patients who have failed with traditional approaches.

Effect of femtosecond laser-assisted lens surgery on the optic nerve head and the macula

AIM: To evaluate the effect of femtosecond laser-assisted lens surgery(FLALS;cataract surgery or refractive lens exchange) on the structure of the optic nerve head and the macula.METHODS: This prospective longitudinal study included healthy eyes undergoing FLALS. Eyes with glaucoma or any other ocular disease that could alter optical coherence tomography results were excluded. Retinal nerve fiber layer(RNFL), Bruch’s membrane opening-minimum rim width(BMO-MRW) and macular thickness(MT) were measured preoperatively, 1 and 6 mo after surgery using spectral-domain optical coherence tomography(SD-OCT). Changes between preoperative and postoperative values were evaluated.RESULTS: A total of 87 eyes of 46 patients were included in this study. Preoperative RNFL, BMO-MRW and MT in microns(μm) were 100.77±10.39, 330.31±49.99 and 276.30±33.39, respectively. Postoperative RNFL, BMO-MRW and MT were 104.74±11.55, 348.32±54.05 and 279.83±22.65 1 mo after surgery and 102.93±11.17, 343.11±53.4 and 278.90±22.19 6 mo after surgery, respectively;which equals an increase of 3.93%, 5.45% and 1.27%,respectively, 1 mo after surgery, and 2.14%, 3.87% and 0.94% 6 mo after surgery. The differences between the preoperative and the postoperative RNFL and BMO-MRW values were statistically significant(P<0.001). Regarding MT values, there were not statistically significant differences(P=0.26).CONCLUSION: Our study suggests that FLALS does not have a negative impact on the structural status of the optic nerve head in healthy eyes, assessed by SD-OCT. There is a slight increase in the values of RNFL, BMO-MRW and MT 1 mo and 6 mo after surgery.

Visco chop-a new technique for nucleus separation for soft cataracts in femtolaser assisted cataract surgery

【正】INTRODUCTION Femtosecond laser technology,introduced clinically for ophthalmic surgery as a technique for creating lamellar flaps in laser in situ keratomileusis(LASIK),has recently been developed into a tool for cataract surgery.Preliminary experience for femtosecond laser-assisted cataract surgery show appropriate safety and efficacy,and possible advantage over conventional cataract surgery[1-4].The ability of the femtosecond laser to fragment the lens results in the need for less ultrasound energy to be expended inside the eye.Several studies indicate that less effective phacoemulsification time is needed to emulsify the lens