Prospective randomized controlled trial to compare the effect on the macula of AquaLase liquefaction and ultrasound phacoemulsification cataract surgery

Purpose

To compare the effect of ultrasound (US) phacoemulsification and AquaLase liquefaction (Alcon Laboratories) cataract surgery on the macula using optical coherence tomography (OCT).

Setting

Department of Ophthalmology, Queen Mary's Hospital, London, United Kingdom.

Methods

Sixty-three patients having cataract surgery were randomized to receive US phacoemulsification or AquaLase liquefaction cataract surgery. Macular thickness and volume were evaluated by OCT preoperatively and 2 and 6 weeks postoperatively. The primary outcomes were OCT central macular thickness and best corrected visual acuity at 6 weeks. Secondary outcomes were OCT macular volume and perioperative and postoperative complications.

Results

Over the 6-week study, the median increase in foveal thickness in the study eye compared with that in the fellow eye was 11 μm (interquartile range [IQR] −21 to 23 μm) in the AquaLase group and 17 μm (IQR −11 to 33 μm) in the phacoemulsification group (P = .229). A subgroup analysis of diabetic patients found a median increase in foveal thickness in the study eye versus the fellow eye of 2 μm (IQR −14 to 23 μm) in the AquaLase group and 29 μm (IQR 11 to 41 μm) in the phacoemulsification group (P = .07).

Conclusions

The results in this study suggest that AquaLase liquefaction cataract extraction is as safe as standard US phacoemulsification cataract extraction and may carry less risk for the development of postoperative cystoid macular edema. This may be most evident in diabetic patients.