Alcon's Aqualase System: A safer approach to cataract surgery?

Implications: This article presents the results of a study comparing standard phacoemulsification to Aqualase.  Complication rates were similar between the two procedures.  The 63 patient study looked in particular at foveal thickening after surgery.  While no statistical significance was demonstrated, the study showed a trend towards less foveal thickening in the Aqualase group for diabetics.  Foveal thickening can be a marker for a common complication after cataract surgery, cystoid macular edema.  Unfortunately, the clinical significance of foveal thickening is often unpredictable.

Analysis: This study certainly does not provide a convincing argument for Aqualase for several reasons.  First, no statistical significance was achieved so it is very difficult to assume that Aqualase causes less foveal thickening.  Second, there is no consensus on what level of foveal thickening is clinically significant.  From a clinical perspective, Aqualase does have its drawbacks particularly in that it is certainly less efficient or not usable for more dense cataracts.  While the technology is worth utilizing for refractive cataract surgery, it is unlikely that it will become the technology of choice for most cataract surgery.