An exploration of safe and efficient nucleus fragmentation strategies for femtosecond laser-assisted cataract surgery in short axial length patients.

Purepose: The intraoperative femtosecond laser time, Cumulative Dissipated Energy (CDE), Effective Phacoemulsification time (EPT), and intraoperative fluid perfusion volume were compared under different model fragmentation modes using Catalys femtosecond laser system.

Methods: This was a single-center, prospective, randomized controlled study. A total of 120 eyes who underwent femtosecond laser-assisted cataract phacoemulsification combined with intraocular lens implantation in Xiamen Eye Center affiliated to Xiamen University from September 2022 to March 2023 were randomly divided into 4 groups to undergo pre-nucleus splitting in different ways: Group 1: six-split, Group 2: eight-split, Group 3: six-split + gridded softening, and Group 4: eight-split + gridded softening. Patient age, gender, LOCS III grade, intraoperative femtosecond laser time, CDE, EPT, and intraoperative fluid perfusion volume were collected and analyzed.

Result: Result SNK test and Bonferroni test showed no significant difference in the nuclear hardness of lens, age, gender, AL, ACD, WTW and LT among the four groups (P > 0.05). Femtosecond laser time: Group 1: 44.87 ± 21.08s; Group 2: 43.10 ± 16.57s; Group 3: 50.70 ± 17.30s; Group 4: 64.04 ± 30.08s. There was no significantly different among groups 1, 2 and 3 (P > 0.05). However, the difference between group 4 and Group 1&2 was statistically significant (P_1.4= 0.006, P_2.4=0.00 2). There were no significant differences in CDE, EPT, and fluid perfusion between the four groups.

Conclusions: Short axial length patients may benefit more from the Catalys femtosecond laser system's six or eight-split nucleus mode Settings, which produce the same or even more effective pre-split treatment than the mesh softening mode while using less femtosecond laser time.