Macular pucker and cataract treated with phacoemulsification and IOL implantation combined with small-gauge pars plana vitrectomy: a comparison of outcomes with and without femtosecond laser assistance
ObjectivesAge-related cataracts and macular pucker are increasingly common. Standard treatment combines phacoemulsification, IOL implantation and small gauge vitrectomy. Recent advancements and acceptance of femtosecond laser (FSL) assistance in cataract surgery have improved precision and outcomes....
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Frontiers Media S.A.
2025-05-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1497776/full |
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| author | Howard Wen-Haur Chao Howard Wen-Haur Chao Cheng-Kuo Cheng Cheng-Kuo Cheng Shiow-Wen Liou Shiow-Wen Liou Hsiao-Ming Chao Hsiao-Ming Chao Hsiao-Ming Chao |
| author_facet | Howard Wen-Haur Chao Howard Wen-Haur Chao Cheng-Kuo Cheng Cheng-Kuo Cheng Shiow-Wen Liou Shiow-Wen Liou Hsiao-Ming Chao Hsiao-Ming Chao Hsiao-Ming Chao |
| author_sort | Howard Wen-Haur Chao |
| collection | DOAJ |
| description | ObjectivesAge-related cataracts and macular pucker are increasingly common. Standard treatment combines phacoemulsification, IOL implantation and small gauge vitrectomy. Recent advancements and acceptance of femtosecond laser (FSL) assistance in cataract surgery have improved precision and outcomes. However, evidence regarding the efficacy and safety of FSL-assisted phacovitrectomy, particularly in Oriental patient populations with distinct anatomical and genetic characteristics, remain limited. This study aims to address this critical gap by comparing the safety and post-operative outcomes of 23- or 25-gauge phacovitrectomy for stage 3 macular pucker and medium density cataract with versus without FSL-assistance (FSLA), in an Oriental patient cohort.MethodsPatients with stage 3 macular pucker and medium-density cataract were recruited and divided into two age-matched groups: group 1 (n = 13) underwent conventional phacovitrectomy without FSLA, and Group 2 (n = 13) underwent phacovitrectomy with FSLA. Evaluations included pre- and postoperative best-corrected visual acuity (BCVA; Snellen E and LogMAR), cataract surgical time, phacoemulsification energy cost, corneal wavefront data, endothelial cell density (ECD), and surgical complications.ResultsSignificant improvements in postoperative visual acuity were observed in both groups (P < 0.05), with Group 2 (FSLA) demonstrating superior outcomes (0.48 ± 0.05/−0.45 ± 0.06; Snellen E/logMAR) compared to Group 1 (0.26 ± 0.07/−0.66 ± 0.15; Snellen E/logMAR). FSLA significantly reduced surgical duration (429.46 s vs. 740.00 s) and cumulative dissipated energy (CDE; 18.90 ± 1.59 vs. 25.24 ± 1.42) without significantly altering higher-order aberrations (0.24 to 0.22 μm). Although ECD decreased postoperatively in both groups, FSLA phacovitrectomy resulted in significantly less endothelial cell loss (227.77 ± 46.85 cells/mm2) compared to conventional phacovitrectomy (389.15 ± 47.87 cells/mm2). No serious complications were reported in either group.ConclusionFSLA phacovitrectomy presents a safe and more efficient alternative over traditional procedures for Oriental patients with medium density nuclear cataract patients with stage 3 macular pucker. Through enhanced IOL centration, shortened surgical times and decreased ECD loss, FSLA led to superior postoperative visual outcomes compared to traditional phacovitrectomy. This study addresses a critical gap in the literature by providing evidence for the benefits of FSLA in Oriental populations, offering valuable insights into its applicability in patients with distinct anatomical variations. |
| format | Article |
| id | doaj-art-930e3dfbdd5047b5b4c44b0e3d654d5b |
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| language | English |
| publishDate | 2025-05-01 |
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| spelling | doaj-art-930e3dfbdd5047b5b4c44b0e3d654d5b2025-08-20T02:55:57ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-05-011210.3389/fmed.2025.14977761497776Macular pucker and cataract treated with phacoemulsification and IOL implantation combined with small-gauge pars plana vitrectomy: a comparison of outcomes with and without femtosecond laser assistanceHoward Wen-Haur Chao0Howard Wen-Haur Chao1Cheng-Kuo Cheng2Cheng-Kuo Cheng3Shiow-Wen Liou4Shiow-Wen Liou5Hsiao-Ming Chao6Hsiao-Ming Chao7Hsiao-Ming Chao8Department of Medicine, School of Medicine, Aston University, Birmingham, United KingdomDepartment of Medical Education, Leeds University, Leeds, United KingdomDepartment of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, TaiwanSchool of Medicine, Catholic Fu-Jen University, Taipei, TaiwanDepartment of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, TaiwanSchool of Medicine, National Taiwan University, Taipei, TaiwanDepartment of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, TaiwanDepartment of Chinese Medicine, School of Chinese Medicine, China Medical University, Taichung, TaiwanInstitute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, TaiwanObjectivesAge-related cataracts and macular pucker are increasingly common. Standard treatment combines phacoemulsification, IOL implantation and small gauge vitrectomy. Recent advancements and acceptance of femtosecond laser (FSL) assistance in cataract surgery have improved precision and outcomes. However, evidence regarding the efficacy and safety of FSL-assisted phacovitrectomy, particularly in Oriental patient populations with distinct anatomical and genetic characteristics, remain limited. This study aims to address this critical gap by comparing the safety and post-operative outcomes of 23- or 25-gauge phacovitrectomy for stage 3 macular pucker and medium density cataract with versus without FSL-assistance (FSLA), in an Oriental patient cohort.MethodsPatients with stage 3 macular pucker and medium-density cataract were recruited and divided into two age-matched groups: group 1 (n = 13) underwent conventional phacovitrectomy without FSLA, and Group 2 (n = 13) underwent phacovitrectomy with FSLA. Evaluations included pre- and postoperative best-corrected visual acuity (BCVA; Snellen E and LogMAR), cataract surgical time, phacoemulsification energy cost, corneal wavefront data, endothelial cell density (ECD), and surgical complications.ResultsSignificant improvements in postoperative visual acuity were observed in both groups (P < 0.05), with Group 2 (FSLA) demonstrating superior outcomes (0.48 ± 0.05/−0.45 ± 0.06; Snellen E/logMAR) compared to Group 1 (0.26 ± 0.07/−0.66 ± 0.15; Snellen E/logMAR). FSLA significantly reduced surgical duration (429.46 s vs. 740.00 s) and cumulative dissipated energy (CDE; 18.90 ± 1.59 vs. 25.24 ± 1.42) without significantly altering higher-order aberrations (0.24 to 0.22 μm). Although ECD decreased postoperatively in both groups, FSLA phacovitrectomy resulted in significantly less endothelial cell loss (227.77 ± 46.85 cells/mm2) compared to conventional phacovitrectomy (389.15 ± 47.87 cells/mm2). No serious complications were reported in either group.ConclusionFSLA phacovitrectomy presents a safe and more efficient alternative over traditional procedures for Oriental patients with medium density nuclear cataract patients with stage 3 macular pucker. Through enhanced IOL centration, shortened surgical times and decreased ECD loss, FSLA led to superior postoperative visual outcomes compared to traditional phacovitrectomy. This study addresses a critical gap in the literature by providing evidence for the benefits of FSLA in Oriental populations, offering valuable insights into its applicability in patients with distinct anatomical variations.https://www.frontiersin.org/articles/10.3389/fmed.2025.1497776/fullfemtosecond laserphacoemulsificationIOL implantsmall gauge pars plana vitrectomyorientalmacular pucker |
| spellingShingle | Howard Wen-Haur Chao Howard Wen-Haur Chao Cheng-Kuo Cheng Cheng-Kuo Cheng Shiow-Wen Liou Shiow-Wen Liou Hsiao-Ming Chao Hsiao-Ming Chao Hsiao-Ming Chao Macular pucker and cataract treated with phacoemulsification and IOL implantation combined with small-gauge pars plana vitrectomy: a comparison of outcomes with and without femtosecond laser assistance Frontiers in Medicine femtosecond laser phacoemulsification IOL implant small gauge pars plana vitrectomy oriental macular pucker |
| title | Macular pucker and cataract treated with phacoemulsification and IOL implantation combined with small-gauge pars plana vitrectomy: a comparison of outcomes with and without femtosecond laser assistance |
| title_full | Macular pucker and cataract treated with phacoemulsification and IOL implantation combined with small-gauge pars plana vitrectomy: a comparison of outcomes with and without femtosecond laser assistance |
| title_fullStr | Macular pucker and cataract treated with phacoemulsification and IOL implantation combined with small-gauge pars plana vitrectomy: a comparison of outcomes with and without femtosecond laser assistance |
| title_full_unstemmed | Macular pucker and cataract treated with phacoemulsification and IOL implantation combined with small-gauge pars plana vitrectomy: a comparison of outcomes with and without femtosecond laser assistance |
| title_short | Macular pucker and cataract treated with phacoemulsification and IOL implantation combined with small-gauge pars plana vitrectomy: a comparison of outcomes with and without femtosecond laser assistance |
| title_sort | macular pucker and cataract treated with phacoemulsification and iol implantation combined with small gauge pars plana vitrectomy a comparison of outcomes with and without femtosecond laser assistance |
| topic | femtosecond laser phacoemulsification IOL implant small gauge pars plana vitrectomy oriental macular pucker |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1497776/full |
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