Abstract
PurposeTo compare the outcomes of femtosecond laser-assisted cataract surgery (FLACS) with those of conventional phacoemulsification surgery (CPS) for age-related cataracts.MethodsA comprehensive literature search of PubMed, EMBASE, and the Cochrane Controlled Trials Register was conducted to identify randomized controlled trials (RCT) and comparative cohort studies comparing FLACS with CPS. Endothelial cell loss percentage (ECL%), central corneal thickness (CCT), corrected and uncorrected distant visual acuity (CDVA and UDVA), and mean absolute error (MAE) of refraction were used as primary outcomes. Secondary outcomes included surgically induced astigmatism (SIA), mean effective phacoemulsification time (EPT), phacoemulsification power and circularity of the capsulorhexis.ResultsNine RCTs and fifteen cohort studies including 4,903 eyes (2,861 in the FLACS group and 2,072 in the CPS group) were identified. There were significant differences between the two groups in ECL% at one week, about one month and three months postoperatively, in CCT at one day, about one month postoperatively and at the final follow-up, in CDVA at one week postoperatively, and in UDVA at the final follow-up. Significant differences were also observed in MAE, EPT, phacoemulsification power, and the circularity of capsulorhexis. However, no significant differences were observed in CDVA at one week postoperatively or in surgically induced astigmatism.ConclusionsCompared to CPS, FLACS is a safer and more effective method for reducing endothelial cell loss and postoperative central corneal thickening as well as achieving better and faster visual rehabilitation and refractive outcomes. However, there is no difference in final CDVA and surgically induced astigmatism between the two groups.
Highlights
Cataract is the leading cause of reversible blindness worldwide, and it can be effectively treated with cataract surgery
Significant differences were observed in mean absolute error (MAE), effective phacoemulsification time (EPT), phacoemulsification power, and the circularity of capsulorhexis
No significant differences were observed in corrected distant visual acuity (CDVA) at one week postoperatively or in surgically induced astigmatism
Summary
Cataract is the leading cause of reversible blindness worldwide, and it can be effectively treated with cataract surgery. With the development of improved equipment and technology over the past few years, cataract surgery is one of the safest and most successful major surgical procedures performed worldwide. [5] Femtosecond laser-assisted cataract surgery (FLACS) offers numerous advantages over current surgical techniques. Studies have shown that use of FLACS leads to more accurate capsulorhexis than the manual procedure in CPS. Previous studies have shown that the pretreatment of cataracts with lasers using FLACS leads to a reduced IOL tilt and improved biometry predictability. [13,14,15] Many recent studies have found that FLACS helps to reduce effective phacoemulsification time (EPT) and the required phacoemulsification energy, thereby diminishing corneal endothelial injury. Previous studies have shown that the pretreatment of cataracts with lasers using FLACS leads to a reduced IOL tilt and improved biometry predictability. [7,10,11] The corneal endothelium plays an important role in maintaining corneal transparency and normal thickness [12], and phacoemulsification time and energy are known to directly cause endothelial cell loss. [13,14,15] Many recent studies have found that FLACS helps to reduce effective phacoemulsification time (EPT) and the required phacoemulsification energy, thereby diminishing corneal endothelial injury. [16,17] Injury reduction of corneal endothelial cells contributes to shorten the recovery period and improve visual outcomes. [1,6] Based on the advantages of FLACS over CPS, some researchers have even predicted that the femtosecond laser will become the standard method of cataract extraction within ten years. [18]
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