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Alteration Of The Inflammatory Profile Of Aqueous After Flacs And Its Comparison

The latest in the list of technologies used for cataract surgery is femtosecond laser-assisted cataract surgery (FLACS) which became a major competitor of already existing phacoemulsification technology used for cataract surgery.

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Alteration Of The Inflammatory Profile Of Aqueous After Flacs And Its Comparison

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  1. Alteration OfThe Inflammatory Profile Of Aqueous After Flacs And Its Comparison WithConventional Phacoemulsification Novel and innovative technologies may not have all the aspects better than the previous technologiesusedinmedical andsurgicalpractices.Whileitmayprovideabetteroutcomeofthe surgicalprocedure,familiaritywiththetechnology andhands-on experienceisaprerequisitefora significantlybetteroutcome.Extensivetrainingofthesurgeons incontext tothesetechnologies manifoldincreases patientsafety, patient comfort,and the ultimateresults. The latestinthe list oftechnologiesusedforcataractsurgeryisfemtosecond laser-assisted cataractsurgery(FLACS)whichbecameamajorcompetitorofalreadyexisting phacoemulsificationtechnologyusedforcataractsurgery.Variousresearchershavecompared the effectofbothtechnologiesbasedontheoutcomeofcataractsurgery.FLACShasits advantages and disadvantage. The benefits offeredbyFLACS includeareductionincornealedema,low phacoemulsificationpower,andminimumcornealendothelialtrauma.However,FLACShasalso known toincreaseprostaglandinlevelsandalterthe cytokineprofilein the aqueous.These disadvantages mayinterferewiththeoverallcataractsurgicalprocedure.

  2. A studyindicatesthatboththetechnologieshavesimilarvisualandrefractiveoutcomeshowever, thefemtosecond lasergroupwasassociatedwithlowPhacoemulsificationenergyandreduced corneal endothelial cellloss.Manyofthestudies donetocompareboththesetechnologieshave studied the impact of FLACS on the inflammatory profile of aqueous but failed to study the overallalterationintheinflammatoryprofileoftheaqueous attheendofcataractsurgery.The finalchanges inthe cytokineprofile andinflammatoryalterationis abetterrepresentationof immediatepostoperativeinflammation. A recentstudyconcludes thatalthoughtheFLACSandconventionalphacoemulsification surgeryprovides similarresults interms ofclinicaloutcomes andsafety,theFLACS hasyetto demonstrateitsimpacton cost-benefitanalysis.Inaliteraturesearch doneon15randomized controlled trialsand22observationalcohortstudiestotalling 14567eyes,itwasconcludedthat althoughtherewerenostatisticallysignificantdifferencesdetectedbetweenFLACSandmanual cataractsurgery,FLACSwasassociatedwithhighposteriorcapsular tearrateandhigher prostaglandin concentration.Anotherstudyindicates theincidencesof posteriorcapsulartearsto be 10-foldhigher inFLACS as comparedto Standardphacoemulsification. ArecentstudyhascomprehensivelycomparedtheprostaglandinE2(PGE2),aqueousoxidative stress andcytokinelevelsafterfemtosecondlaser-assistedcataractsurgeryversus conventionalphacoemulsification.Thestudyalsostudiedtheimpactofanonsteroidalanti- inflammatorydrug(NSAID) on theinflammatoryprofile ofaqueous. Therandomizedcontrolledstudywasconductedon70patientsandwasheldataSingaporean hospital.70patientswere dividedintotwogroups of35patientseach.Whilethefirstgroupwas treatedto comparetheeffectofboththetechnologies, theothergroup wastreated toconclude the effect of NSAIDs on the inflammatory profile in FLACS. During the screening process, the patientswithco-morbidoculardiseaseandwhowereonNSAIDswereexcludedas thedrugmay interferewiththe result. In thegroupfirst,thepatientundergoeseitherthe conventionalsurgeryortheFLACS surgeryonarandombasis.Inthefirststage,thesurgery,eitherconventional orFLACS is performedontherighteye.After 3-4 weeks ofthesurgeryinthefirsteye,thepatientshave subjectedtothesurgeryinthesecondeyeinsucha mannerthatboththeeyesofeachpatient havedifferenttypesofsurgeries.Thesurgerywas doneunderthe effectoflocalanesthesia.The propertopical antibioticregimenwasfollowedbyadministeringantibiotic eyedrops atregular intervalsbeforethesurgery.TheFLACSsurgerywasperformedusingtheLDVZ8system (ZiemerOphthalmicSystems,Port,Switzerland).ThepatientsrandomizedforNSAIDs preoperativelytoFLACSreceived0.4%topicalketorolactromethaminefourtimesdaily24hours beforesurgery.The steps ofFLACS surgeryin thesecond groupinvolves anteriorcapsulotomy, lens fragmentation,and cornealincision.

  3. The aqueoushumorwascollectedinallthesubjectsafterphacoemulsification,before phacoemulsificationinthe patientswhohadundergonephacoemulsificationsurgeryandafter laserpretreatmentinthegroupin whichtheeffectofNSAID hastobestudied.Theinflammatory parameters thatarestudiedinclude prostaglandinE2(PGE2),levels ofmalondialdehyde,and variouscytokines.Clinicalflareandthe sizeofthepupilwasalsocomparedamonggroups.The aqueous humor was collectedthroughlimbalparacentesis. The result indicatedthatFLACS hadasignificantlyhigherlevelofPGE2andPGE2and interleukin-1receptorantagonist (IL-1RA)afterlaserpretreatmentascomparedto conventionalphacoemulsification procedure.PreoperativeuseofNSAIDs broughthigher levels,duetoFLACS,down,likethe levelsseen inconventionalphacoemulsification.Itwasalso seenthatintraoperativemiosisalsooccurredwithFLACShowever,withthepreoperativeNSAID use,this problem wassignificantlyreduced.Therewasnostatisticallysignificantdifference betweenthelevelofmalondialdehydeandclinicalflare.Postphacoemulsificationprocedure, the levelofPGE2rises inall thegroups withoutanystatisticaldifference.A correlationbetweenthe increaseinthelevelofmalondialdehydeandtheeffectivephacoemulsificationtimewasalso found.DuringtheFLACS,freeradicals areproducedthatmaydamagethe cornealendothelium. Thestudyindicatesthattherewas nosignificantdifferencebetweentheoxidativestressbetween boththegroups.This maybebecause alow-energyfemtosecondlaserhasbeenusedinthestudy whichhasalowfree-radicalgeneratingcharacteristic.Ahigh-energyfemtosecondlasermight havechangedtheresultrelatedtooxidativestress andmayprovideastatisticallysignificant differencebetweenboththetechnologies. This study is important due to the first of its kind to compare the inflammatory condition of the aqueousafter thecompletephacoemulsificationprocedure. Thisstudyconcludedthatalthough NSAIDs reducethe level ofprostaglandins afterlaserpretreatmenthowever,theNSAIDfailsto providereliefinthelevel ofPGE2afterphacoemulsification.20%ofthepeoplewithFLACS- NSAIDgrouphadintraoperativemiosis indicatingtheinvolvement ofanothermechanism/s in developingintraoperativemiosis alongwithinflammation. Evenwithcertainlimitations,thestudyis important as ithasthrowna lightonvarious aspects relatedtoFLACSandphacoemulsificationandprovidesanunderstanding oftheimpactof NSAIDon the FLACS outcome.

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