OFF CENTER PUPIL TRIAL
This trial included patients undergoing cataract surgery between July 2017 and March 2021 at Eye Center, Second Affiliated Hospital, College of Medicine, Zhejiang University. This trial was registered at (identification number ChiCTR-ONN-17010319).
After receiving a complete explanation of the study, all patients signed the written informed consent. This prospective, examiner-blinded consecutive cohort study was performed with the approval of the Institutional Review Board of the Second Affiliated Hospital of the School of Medicine, Zhejiang University, Hangzhou, China, and in accordance with the tenets of the Declaration of Helsinki. Thus, the aim of this study was to compare the visual outcomes and photic phenomena between FLACS and CPS in cases implanted with the TECNIS Symfony IOL. 12 Although a large number of comparative studies have been conducted on femtosecond laser–assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS), no larger sample clinical data, implanting with an EDOF IOL, have been published yet. In recent years, with the advent of femtosecond lasers in cataract surgery, an anterior capsulotomy can be centered on the pupil center, pupil maximized center, lens center of the scanned capsule, or custom placement, with a predictable and more regular ring-shaped capsule rupture. 7,8 The complex optical design of an EDOF IOL showed higher sensitivity to decentration, which might lead to larger HOAs. 6 Higher-order aberrations (HOAs) can produce visual errors, such as night vision difficulties and glare, halos, and other light disturbances, which could lead to falls, postural stability, and other difficulties in activities of daily living. 5 If the capsulotomy is too large, the IOL optical system might be tilted or decentered, resulting in optical aberrations and damage to the retinal image. 4 The architecture of the capsulorhexis has a great influence on the position of the lens, which in turn affects the refractive effect. The decentration and tilt of the IOL is a crucial factor influencing the visual quality of patients postoperatively. 1 The extended depth-of-focus (EDOF) IOL TECNIS Symfony (Johnson & Johnson Vision), a new concept IOL, based on a proprietary achromatic diffraction echelette design, is proven to be capable of restoring the patient's far, intermediate, and part of near vision, producing EDOF and minimal interference light phenomenon. With the implantation of an EDOF IOL, FLACS could precisely control the shape and size of the capsulotomy and induce a significantly better-centered IOL, leading to higher visual performance compared with CPS.Īt present, cataract surgery, which was originally only used monofocal intraocular lenses (IOLs) to restore vision at 1 specific distance, has evolved into refractive cataract surgery. With regard to photic phenomena, the FLACS group received better outcomes ( P <. The FLACS group achieved higher CS at 6 to 18 cycles per degree under glare condition ( P <. As for defocus curve, FLACS was better at −1.00 diopter ( P <. With IOL decentration of more than 0.40 mm, total internal aberration ( P =. 001), higher-order aberrations (HOAs) ( P =. FLACS presented a significantly lower total aberration ( P <. FLACS demonstrated a significantly lower IOL decentration ( P =. The circularity index of FLACS was more precise than that of CPS ( P =. Results:Ģ61 patients (261 eyes) were enrolled. Main outcome measures were postoperative examinations that included defocus curves, contrast sensitivity (CS), optic path difference aberrometry scan, anterior segment photography, and questionnaires. Patients were given the option to choose FLACS or CPS and were implanted with a TECNIS Symfony. Setting:Įye Center, the Second Affiliated Hospital of Zhejiang University, Zhejiang, China. To investigate the visual quality after femtosecond laser–assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS) with the implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL) TECNIS Symfony.
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