Purpose To compare the pupil changes in low-energy femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification (CP) intraindividually. Patients and Methods A retrospective review of registered surgical data from patients that undergone uncomplicated cataract surgery in a single centre, with randomly assigned femtosecond laser–assisted cataract surgery (FLACS) to one eye and conventional phacoemulsification (CP) to the other, was performed. The recorded pupil images were evaluated at pre and post laser treatment (after suction release) and at several surgical timepoints for both techniques (FLACS and CP). Pupil areas were calculated and compared in the same eye undergone FLACS (pre vs post laser treatment), between eyes (CP vs FLACS) in the same patient and between groups. Subgroups were built regarding age and ocular comorbidity. Results This study involved a total of 164 eyes of 82 patients (55 female, 27 male). No statistical differences regarding the total duration of surgery (p=0.805) between FLACS and CP. Pupil measurements between pre and post laser treatment in the FLACS group showed no statistically significant differences (p=0.107). The mean change in pupil area from the beginning until the end of surgery (total variation) was 6.59±2.08 mm 2 in the FLACS group and 6.67±2.13 mm 2 in the CP group, associated to less narrowing of pupil area with FLACS, although not statistically significant (p=0.080). Comorbidity group analysis revealed less, but not significant, pupil narrowing with the FLACS technique (p=0.071). No statistically significant differences between FLACS and CP concerning age subgroups were registered. Conclusion This study shows no significant pupil changes, namely myosis, after low-energy FLACS pre-treatment. Comparison between techniques showed less pupil variation in FLACS as compared to CP, more markedly in eyes with comorbidities (particularly with shallow anterior chamber), although non-statistically significant.

Background: Lens surgery with multifocal IOL implantation for presbyopia correction is performed by femtosecond laser-assisted lens surgery or conventional phacoemulsification. Objective: To compare the clinical results of femtosecond laser-assisted with low-energy pulse conventional phacoemulsification lens surgery for presbyopia correction intraindividually. Methods: Charts from patients who underwent Refractive Lens Exchange (RLE) for presbyopia correction in a single center, with Femtosecond Laser-Assisted Lens Surgery (FLALS) in one eye and Conventional Phacoemulsification (CP) in the other, were retrospectively reviewed. All eyes had the same multifocal Intraocular Lens (IOL) implanted. The clinical outcomes and the results of the level of satisfaction questionnaire were compared between the two groups according to the technique employed (FLALS vs. CP) for a period of up to four years. Stability, efficacy and safety indices were also assessed. Results: This study comprised a total of 56 eyes of 28 patients randomly assigned FLALS in one eye and CP in the other. No statistically significant difference was observed between the two techniques regarding postoperative visual acuities, duration of surgical procedure, efficacy or safety indexes (p>0.05). Refraction was stable in all FLALS eyes, whereas a change occurred in 2 eyes (7.1%) operated with CP upon 6 months postoperatively, but without statistical significance (p˃0.05). Satisfaction was slightly better with FLALS but not statistically significant (p=0.134). No immediate myosis or other adverse events after the femtosecond laser were registered. Conclusion: The parameters assessed showed no significant differences between the two techniques, in spite of a difference of refraction stability upon 6 months postoperatively.

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