Intra and post-operative complications observed with femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery: a systematic review and meta-analysis

Jinhua Wang,Qiao Chen,Yong Wang,Fanfan Su,Yao Chen,Fen Li

doi:10.1186/s12886-019-1190-2

Abstract

BackgroundIn this analysis, we aimed to systematically compare the complications which were associated with femtosecond laser-assisted cataract surgery (FLACS) versus the conventional phacoemulsification surgery (CPE).MethodsCommonly used search databases, specifically MEDLINE, Cochrane Central, EMBASE, and http://www.clinicaltrials.gov were carefully searched for English publications comparing FLACS versus CPE. The selected endpoints which were assessed included incomplete capsulotomy, anterior capsulotomy tag, anterior capsule tear, posterior capsule tear, injury to the descemet’s membrane, zonular dialysis, vitreous loss, macular or corneal edema, and elevated intra-ocular pressure. Statistical analysis was carried out by the latest version of the RevMan software (version 5.3) and represented by risk ratios (RR) with 95% confidence intervals (CI).ResultsA total number of 7156 participants were included. Three thousand five hundred and fifty four (3554) participants were assigned to the FLACS group. The risks for incomplete capsulotomy, anterior capsulotomy tag, and anterior capsular tear were significantly higher with FLACS (RR: 22.42, 95% CI: 4.53–110.82; P = 0.0001), (RR: 33.07, 95% CI: 6.53–167.56; P = 0.0001) and (RR: 4.74, 95% CI: 2.59–8.68; P = 0.00001) respectively. The risks for macular/corneal edema (RR: 2.05, 95% CI: 1.18–3.55; P = 0.01) and elevated intra-ocular pressure (RR: 3.24, 95% CI: 1.55–6.78; P = 0.002) were also significantly higher with FLACS. However, the risks for impaired descemet’s membrane (RR: 0.95, 95% CI: 0.61–1.47; P = 0.80), zonular dialysis (RR: 0.40, 95% CI: 0.06–2.72; P = 0.35), vitreous loss (RR: 0.09, 95% CI: 0.01–1.63; P = 0.10) and posterior capsular tear (RR: 1.45, 95% CI: 0.23–9.16; P = 0.69) were not significantly different.ConclusionsThe current results showed that FLACS did not improve intra/post-operative complications in comparison to CPE. Further larger studies should confirm this hypothesis.

Highlights

In this analysis, we aimed to systematically compare the complications which were associated with femtosecond laser-assisted cataract surgery (FLACS) versus the conventional phacoemulsification surgery (CPE)
The risks for incomplete capsulotomy, anterior capsulotomy tag, and anterior capsular tear were significantly higher with FLACS (RR: 22.42, 95% confidence intervals (CI): 4.53–110.82; P = 0.0001), (RR: 33.07, 95% CI: 6.53–167.56; P = 0.0001) and (RR: 4.74, 95% CI: 2.59–8.68; P = 0.00001) respectively
The risks for macular/corneal edema (RR: 2.05, 95% CI: 1.18–3.55; P = 0.01) and elevated intra-ocular pressure (RR: 3.24, 95% CI: 1.55–6.78; P = 0.002) were significantly higher with FLACS

Summary

Introduction

We aimed to systematically compare the complications which were associated with femtosecond laser-assisted cataract surgery (FLACS) versus the conventional phacoemulsification surgery (CPE). In this modern developing society, the total number of people undergoing eye surgery is gradually increasing [1]. Agarwal’s et al recent study based on current and effective features of femtosecond laser-assisted cataract surgery (FLACS) showed that surgeons might be more confident and patients might be more satisfied with FLACS, but a few studies showed that this surgery was not a better option when compared to the manual phacoemulsification in terms of outcomes and complications [2]. We aimed to systematically compare the intra/post-operative complications which were associated with FLACS versus the conventional phacoemulsification surgery (CPE)

Objectives

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Results

Discussion

Conclusion