Clinical Outcomes of FLACS with Crater phaco-chop Technique for Grade 5 Leathery Brown Nuclear Cataracts

Objective: This study evaluated the efficacy and safety of Femtosecond Laser-Assisted Cataract Surgery (FLACS) with crater phaco-chop technique for treating grade 5 leathery brown nuclear cataracts, compared to standard FLACS phaco-chop technique. Methods: A retrospective analysis was conducted on patients with grade 5 cataracts who underwent either FLACS+phaco-chop (Group 1) or FLACS+crater+phaco-chop (Group 2). Outcome measures included intraoperative complications, cumulative dissipated energy (CDE), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), and central corneal thickness (CCT) at baseline and postoperatively at various time points. Results: Preoperative characteristics were similar between groups. During surgery, Group 1 encountered one case of posterior capsular rupture (PCR) and two anterior capsular tears. Intraoperative CDE was significantly lower in Group 2 compared to Group 1 (P=0.026). Postoperative CCT was significantly thinner in Group 2 on the first day after surgery (P=0.042). The rate of ECD loss was consistently lower in Group 2 across all follow-up time points (P < 0.05). Conclusion: Utilizing the crater phaco-chop technique in FLACS for treating grade 5 leathery brown nuclear cataracts reduces corneal endothelial damage and minimizes intraoperative complications compared to traditional FLACS, ensuring a more secure and efficient cataract extraction.