PURPOSE: To compare the efficacy and safety outcomes
of bimanual microincision cataract surgery (MICS) versus
2.2-mm coaxial phacoemulsification assisted by Femtosecond
LenSx (Alcon-LenSx Inc., Aliso Viejo, CA).
METHODS: This prospective, randomized, observational,
comparative case series comprised 50 cataractous
eyes of 50 patients receiving femtosecond laser refractive
lens surgery followed by a bimanual MICS technique
with two 1-mm incisions (25 patients) (FemtoMICS
group) and a coaxial phacoemulsification technique with
a 1-mm paracentesis and a 2.2-mm principal incision
(25 patients) (FemtoCoaxial group). The main outcomes
measures were: ultrasound power, effective phacoemulsification
time, postoperative spherical equivalent,
higher-order aberrations (corneal and internal), corneal
thickness, endothelial cell count, macular thickness, and
complications during and after surgery. Both groups were
absolutely comparable for all variables preoperatively.
RESULTS: Mean ultrasound power was 1.8% ± 0.9%
for MICS and 14.7% ± 4.9% for 2.2-mm incisions (P
< .001). Effective phacoemulsification time values for
MICS and 2.2-mm incisions were 1.5 ± 0.9 and 4.5
± 2.9 sec, respectively (P = .002). Mean postoperative
spherical equivalent was -0.26 for FemtoMICS and
-0.33 for FemtoCoaxial (P > .05). The efficacy index at 1
month postoperatively was 160.2% for FemtoMICS and
149% for FemtoCoaxial. No significant differences were
found in corneal thickness, endothelial cell count, and
macular thickness. Complications included posterior capsule
rupture (4%) and anterior capsule rupture with no
posterior capsule tear (4%) for FemtoMICS and bridges
due to incomplete capsulorhexis (4%) for FemtoCoaxial.
CONCLUSIONS: MICS and coaxial phacoemulsification
techniques assisted by the Femtosecond LenSx
achieved excellent safety and efficient outcomes. The
FemtoMICS technique was surgically and statistically
more efficient than the FemtoCoaxial technique.