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Femtosecond laser-assisted cataract surgery is safe and effective for use in combination with non-penetrating deep sclerectomy in glaucoma patients, Prof Svetlana Anisimova, Moscow, Russia, told the XXXII Congress of the ESCRS in London. 
In a case comparison study, vacuum docking during the femtosecond laser step did not raise intraocular pressure (IOP) excessively, and complication rates and visual outcomes were similar to patients undergoing conventional phacoemulsification.
Prof Anisimova compared results of 53 glaucoma patients receiving combined sclerectomy and femtosecond laser-assisted cataract surgery with 21 receiving combined sclerectomy and conventional phaco. Also compared were 150 non-glaucoma patients receiving conventional phaco and 145 receiving femtosecond laser-assisted phaco.
All femtosecond laser procedures used the Bausch + Lomb VICTUS platform for capsulorhexis, lens fragmentation and lens incisions, and all phaco in all procedures was done with the Stellaris device. Xenoplast collagen drainage devices were implanted in the sclerectomy procedures to help maintain aqueous outflow and reduce bleb fibrosis.

IOP and visual outcomes
After applying the laser vacuum docking ring, IOP in the femtosecond laser combined procedure group ranged from 14 to 38mmHg, depending on the severity of glaucoma, Prof Anisimova reported. Docking added a load of 10N, and patients did not lose light perception during the procedure.
After surgery, IOP declines were similar for the femtosecond laser and conventional phaco combined procedure groups, respectively declining from pre-op means of 26.4mmHg and 30.1mmHg, to 24.8 and 29.1mmHg one day after surgery; 16.4 and 19.4mmHg at seven days; and 16.9 and 18.1mmHg at six to 12 months. Patients receiving femtosecond laser-phaco or phaco without sclerectomy saw slight increases in IOP one day after surgery, returning to close to preoperative levels at six to 12 months.
Mean best corrected visual acuity improved similarly in all groups, from about 0.2 or 20/100 pre-op to about 0.7 or 20/30 one month post-op. Outcomes were similar between patients with and without glaucoma. Overall, complications were low in all groups, though a few complications specific to the femtosecond laser stage were observed, Prof Anisimova said. 
Early on, pupil constriction occurred in 30 per cent of cases, though this was reduced to 12 per cent by using mydriatics and non-steroidal anti-inflammatory drops one day before surgery. 
Vacuum was lost in one case leading to laser tracing on the patient’s iris, though this did not affect visual outcome, she added. The data suggest that femtosecond laser cataract surgery is safe for use in glaucoma patients receiving combined procedures, Dr Anisimova concluded.
Svetlana Anisimova:

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