Pilot study on erbium laser phacoemulsification

Purpose: To investigate the suitability of erbium laser phacoemulsification for cataract surgery using a prospective pilot study. Design: Prospective, single-center, nonrandomized clinical trial. Patients and Methods: Slit-lamp microscopy, keratometry, best-corrected vis ual acuity, refraction, pachymetric corneal thickness, endothelial cell den sity, and intraocular pressure were assessed before surgery and on the firs t, fourth, fourteenth, and the sixtieth day after surgery in 40 eyes of 34 patients with senile cataract (17 males with a mean age of 67.3 years; 17 f emales with a mean age of 73.2 years). All operations were performed by one surgeon (HH) using the MCL-29 erbium laser (Aesculap-Meditec, Jena, German y). The nuclear sclerosis grade ranged from 0 to 4. Main Outcome Measures: Primary outcome measures were defined as the ability to emulsify the lens nucleus under clinical conditions and the occurrence of side effects. Secondary outcome measures included the change in visual a cuity, refraction, intraocular pressure, corneal thickness, and endothelial cell density. Results: Complete emulsification of the lens nucleus using the erbium laser was achieved in 36 of 40 eyes (90%; nuclear sclerosis grade, 0-3). Partial emulsification of the nucleus was possible in two cases with grade 3 nucle ar sclerosis, in one case of grade 2 nuclear sclerosis, and in one case of cataract with grade 4 nuclear sclerosis. Mean phacoemulsification time was 3 minutes, and the total applied energy equaled 38.5 J. The postoperative c hanges in visual acuity, spherical and astigmatic refraction, and intraocul ar pressure were found to be the same as with ultrasonic phacoemulsificatio n. The decrease in the density of endothelial cells (by 0.96%) was not stat istically significant. Posterior capsule ruptures occurred in three eyes ea rly in the series. There were no further vision-threatening complications. Conclusions: Erbium laser phacoemulsification is effective for lenses with mild to moderate nuclear sclerosis. For higher grades of nuclear sclerosis, further improvements in technical and surgery-related parameters are requi red. Ophthalmology 2000;107:1053-1062 (C) 2000 by the American Academy of O phthalmology.