Efficacy and safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract: a meta-analysis of randomized controlled trials

Abstract

The aim of this study was to evaluate the efficacy and safety of femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification cataract surgery (CPCS) in the treatment of cataract. Randomized controlled trials (RCTs) were searched in PubMed, Embase and the Cochrane Central Register of Controlled Trials. Nine qualified studies with a total of 989 eyes were included. Compared with CPCS, FLACS significantly reduced mean phaco energy and effective phacoemulsification time (EPT) required in the surgery. Central corneal thickness (CCT) was significantly lower in FLACS at 1 day of follow-up, but CCT and corneal endothelial cells count was comparable at 1 week of follow-up or longer. FLACS achieved a better visual outcome at postoperative 1 week and 6 months, but the difference was not significant at postoperative 1–3 months. Regard to surgical complications, the incidences of intraoperative anterior capsule tear, postoperative macular edema and elevated intraocular pressure were similar. In conclusion, femtosecond laser pretreatment can reduce phaco energy and EPT, which may reduce the heat damage to ocular tissues by ultrasound. This novel technique might be beneficial for patients with dense cataract and/or low preoperative endothelial cell values. Well-designed RCTs with longer follow-up are still necessary to provide more reliable evidence.

Financial modelling of femtosecond laser-assisted cataract surgery within the National Health Service using a ‘hub and spoke’ model for the delivery of high-volume cataract surgery

“…First, we are awaiting clinical results from large RCTs comparing FLACS with CPS 1112 The latest meta-analysis shows no significant advantages in terms of safety of FLACS over CPS 10. However, there are advantages in terms of endothelial cell loss, effective phacoemulsification time and unaided visual acuity, albeit no difference in long-term best-corrected visual acuity and an increased risk of anterior capsular tear 18.…”

“…11 12 The latest meta-analysis shows no significant advantages in terms of safety of FLACS over CPS. 10 However, there are advantages in terms of endothelial cell loss, effective phacoemulsification time and unaided visual acuity, albeit no difference in long-term best-corrected visual acuity and an increased risk of anterior capsular tear. 18 We assumed in our financial modelling that there are no differences in outcomes and complication rates between the two procedures.…”

“…Within the scientific literature, there are now numerous prospective case series supporting its usage and continued development and more surgeons are adopting this new technology 4–9. However, while FL technology undoubtedly offers great surgical precision, a recent meta-analysis shows no significant advantages in terms of safety and efficacy of FL-assisted cataract surgery (FLACS) over conventional phacoemulsification cataract surgery (CPS) 10. Two large multicentre randomised controlled trials (RCTs) are currently underway in France and the UK and may provide further evidence as to whether there is a difference in the clinical outcomes from FLACS 11…”

“…10 Two large multicentre randomised controlled trials (RCTs) are currently underway in France and the UK and may provide further evidence as to whether there is a difference in the clinical outcomes from FLACS. 11 12 Until evidence exists of improved surgical outcomes, it is difficult at present to support the widespread implementation of FLACS.…”

Of emperors and clothes: why FLACS?

“…The early promise of FLACS generated much optimism regarding its potential . Now several years later, with more than 250 peer‐reviewed articles on this application of femtosecond technology published, the overwhelming impression is that there is no routinely measurable visual benefit over the current standard of manual phacoemulsification surgery . The bar is admittedly high because the standard surgery has proven to be such a good operation.…”