Corneal incision architecture: VICTUS femtosecond laser vs manual keratome

Renan Rodrigues,¹ Myrna Serapião Dos Santos,^1,2 Rachel E Silver,³ Mauro Campos,^1,2 Rachel LR Gomes<sup>1,2

1</sup>Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil; ²Cataract Department, Hospital de Olhos Paulista, Sao Paulo, Brazil; ³Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA

Purpose: To evaluate anatomical differences between laser (VICTUS) and manual constructed phacoemulsification incisions.
Setting: Study was conducted at the Hospital de Olhos Paulista, Sao Paulo, Brazil.
Design: This is a prospective, observational, consecutive nonrandomized cohort.
Patients and methods: Sixteen patients (18 eyes) had phacoemulsification surgery, nine eyes had manual incisions and nine eyes had femtosecond incisions. All incisions were performed by the same surgeon. All incisions were evaluated at the 1st and 30th postoperative day with anterior segment optical coherence tomography to evaluate anatomical features. Inclusion criterion was presence of low visual acuity due to cataract. Exclusion criteria were other ocular pathologies, previous trauma, or corneal wound healing disease, as any intra or postoperative complication. Three different corneal specialists analyzed wound architecture features (epithelial or endothelial gap, incision edema, number of planes, Descemet’s detachment, and loss of wound sealing) at both visits. ImageJ (National Institutes of Health) software was also used to analyze anatomical features of incisions.
Results: Almost all incisions had edema at the first postoperative day. All femto incisions were triplanar, as intended, unlike manual incisions, which showed two uniplanar incisions (P=0.009). All laser incisions presented partial loss of wound sealing, while five keratome incisions had no loss of wound sealing at the first postoperative day (P=0.03).
Conclusion: These findings support the hypothesis that laser constructed incisions are more precisely constructed than manual, although corneal wound healing was similar between the two groups at the 30th postoperative day, with a tendency to a faster anatomical improvement in the keratome group.

Keywords: phacoemulsification, cataract, femtosecond laser, optical coherence tomography, cornea