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AquaLase may provide a better method of cataract removal than phacoemulsification in diabetic patients, a recent study suggests.

There was a trend toward less foveal thickening in patients with diabetes with the pulsed-saline technology than with phaco, according to Allon Barsam, MBBS, MA, MRCOphth, and colleagues at St. Thomas’ Hospital in London.

The researchers presented the results of their study in a poster at the American Academy of Ophthalmology annual meeting in Las Vegas. The AquaLase cataract removal technology is a feature on the Alcon Infiniti Vision System. The Infiniti also incorporates ultrasound phacoemulsification.

“Our research has shown a statistical trend to favoring AquaLase over traditional phaco for the prevention of postoperative [cystoid macular edema] in diabetic patients,” he told Ocular Surgery News in an e-mail interview. “AquaLase may be the procedure of choice for cataract surgery in this group of patients.”

The study

Dr. Barsam told OSN he pursued this research because he believed that Aqualase, in which warmed balanced salt solution is pulsed into the eye to remove a cataract, may cause less CME than ultrasound phaco.

“I thought that due to the fact that no heat or ultrasonic vibration is produced in the eye with AquaLase (unlike phacoemulsification) that there may be less microtrauma and consequently less CME with AquaLase,” he said.

The study included 63 patients randomly assigned to undergo AquaLase (32) or phacoemulsification (31).

Optical coherence tomography was performed preoperatively and then at 2 and 6 weeks postoperative, and the operated eye was compared with the unoperated fellow eye.

“We looked at general perioperative complications, which were equivalent in the two groups,” Dr. Barsam said.

The results

The study showed that both groups had increased foveal thickening, but when the researchers did a subgroup analysis of diabetic patients, they saw a trend toward greater foveal increase with ultrasound than AquaLase at 6 weeks. The difference was not statistically significant.

“The statistics show a statistical trend toward favoring AquaLase in diabetic patients,” Dr. Barsam said. “This group probably does have the most favorable outcome with respect to CME with AquaLase.”

AquaLase cataract extraction resulted in lower CME risk than standard phacoemulsification, especially in diabetic patients, the study concluded, but Dr. Barsam said that a study in a larger number of patients is needed.

“We are currently seeking to recruit for a further study looking only at diabetic patients with larger numbers of patients in order to show a statistically significant difference between the two techniques of cataract surgery,” he told OSN.

Dr. Barsam said that the AquaLase technique is mainly used in clinical trials where he practices in the United Kingdom. It is not otherwise in widespread use there.

For more information:

• Allon Barsam, MBBS, MA, MRCOphth, can be reached at St. Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH U.K.; +44-020-7188-7188; e-mail: abarsam@hotmail.com. Dr. Barsam has no direct financial interest in any of the products mentioned in this article.

• Alcon, the makers of the AquaLase, can be reached at 6201 South Freeway, Fort Worth, TX 76134 U.S.A.; +1-817-293-0450; fax: +1-817-568-6142; Web site: www.alconlabs.com.

• Katrina Altersitz is an OSN Staff Writer who covers all aspects of ophthalmology.