Surgical procedure
LENS, CORTEX, IOL
The same surgeon performed all surgeries.The FLACS group performed pretreatment using the LenSx laser (Alcon Laboratories, Fort Worth, TX, USA). After successfully coupling the laser-patient interface, spectral domain optical coherence tomography imaging of the anterior segment was performed. Further, laser treatment was initiated and included the creation of a 5.5-mm capsulotomy and lens fragmentation (LenSx pattern: concentric cylinders and segmental cuts). Once pretreatment was completed, a 1.2-mm one-plane paracentesis and a 2.75-mm two-plane main incision were made using disposable keratome knives, following phacoemulsification, performed using the Centurion System (Alcon Laboratories, Fort Worth, TX, USA). A dispersive viscoelastic was injected into the anterior chamber to protect the endothelium. The anterior capsule was removed using utrata forceps and hydrodissection followed. Surgery was then completed with the standard phacoemulsification procedure. The remaining cortex was removed through coaxial irrigation/aspiration, followed by IOL implantation. Stromal hydration was applied to close the corneal incisions at the end of the procedure. A combined steroid-antibiotic ointment was placed on the eye, and then the eye was covered with a clear acrylic shield.In the PHACO group, a 1.2-mm one-plane paracentesis and a 2.75-mm two-plane main incision were made using disposable keratome knives. Continuous curvilinear capsulorrhexis was completed using utrata forceps through the main incision. Surgery was then completed with the standard phacoemulsification procedure with a phacochop technique. The remaining steps were similar to those described in the FLACS group.