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Monocentric Experience with Erbium Laser Phacoemulsification - Results of the first 1000 Operations
Frano L., Höh H.,
Klinikum Neubrandenburg, Klinik für Augenheilkunde (Neubrandenburg)
Purpose: Ultrasonic phaco emulsification (USP) was compared to erbium laser phacoemulsification (ELP). Both procedures were performed by the same surgeon.
Method: Out-patient surgery was performed at the Eye Hospital of Neubrandenburg, Germany, by ELP (1024 eyes of 857 patients; 362 male, 495 female, age 17 - 94 years, m = 66.5 years) and USP (409 eyes of 330 patients; 125 male, 205 female, age 37 - 92 years, m = 73.5 years). USP was done by ultrasonic phaco machine HARMONY (DORC, Netherlands); phaco time was mea-sured and converted to energy. ELP was done by PHACOLASE (Asclepion-Meditec Co., Jena, Germany). Phaco time and energy were read from the machine's display. Nucleus hardness was determined intraoperatively after the Neubrandenburg scale (0 - 4). Surgical technique was similar in both groups (clear corneal incision, phaco chop technique, implantation of a flexible intraocular silicone lens etc.).
Results: Phaco times in USP/ELP were as follows: nucleus hardness 0: 0.7 s/7.5 s, nucleus hardness 1: 9.6 s/57.6 s, nucleus hardness 2: 23.7 s/106.9 s, nucleus hardness 3: 39.3 s/215.1 s, nucleus hardness 4: 68.9 s/232.0 s. Energy in USP/ELP was as follows: nucleus hardness 0: 7.2 J/0.9 J, nucleus hardness 1: 96.7 J/23.5 J, nucleus hardness 2: 237.3 J/53.1 J, nucleus hardness 3: 392.5 J/149.1 J, nucleus hardness 4: 688.6 J/176.6 J. Complication rates were not different.
Conclusions: Dependent on nucleus hardness, ELP takes seconds up to a few minutes longer than USP. But energy transfer into the eye is almost one order of magnitude less than with USP. ELP method is safe and effective in nuclear densities up to 2.5.