Nanosecond Laser Cataract Surgery with Soft-Shell technique: Effect on Endothelial Cell Loss

Purpose: The primary aim was to compare endothelial cell loss following NanoLaser cataract surgery with and without the integration of the Soft-Shell technique. Methods Digital records of eyes with LOCS III grade 2 or 3 cataracts that underwent uncomplicated surgery for removal without post-operative complications or secondary procedures at Hildesheim-Alfeld-Bockenem Eye Center (Hildesheim, Germany) were included in the quality control single-center two surgeon non-randomized retrospective cross-sectional study. Inclusion criteria included one baseline and at least one follow-up automated non-contact specular microscopy for endothelial cell density, rate of polymegethism represented by coefficient of variance, and pachymetry. Surgical procedures were performed by two surgeons using a standardized bimanual cataract extraction procedure without intraocular antibiotics, with one also integrating the Soft-Shell technique. Results Fifty-five eyes of 36 patients were enrolled. Comparison of laser energy required to complete surgery for the two groups did not yield statistically significant differences. Differences in the modification of endothelial cell density, coefficient of variance and central corneal thickness during the follow-up period between the two groups were not statistically significant. The number of cells lost due to surgery was calculated by using linear regression analysis, showing that NanoLaser + Soft-Shell procedure induced a cell loss of -46 ± 88 cells and the NanoLaser procedure 155 ± 87 cells (p = .002). Conclusions NanoLaser cataract surgery used less energy and did not require intraocular antibiotics (all single-use instruments) thus reducing endothelial cell loss. With the addition of the Soft-Shell technique this sparing was even greater.