Comparing the Curative Effects between Femtosecond Laser-Assisted Cataract Surgery and Conventional Phacoemulsification Surgery: A Meta-Analysis

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.

A randomized controlled trial comparing femtosecond laser–assisted cataract surgery versus conventional phacoemulsification surgery

“…A meta-analysis of FLACS vs CPS performed by Chen et al, identified 9 randomised controlled trials (RCTs) 1,2,[5][6][7][8][9][10][11][12][13] . Overall, they found that FLACS significantly reduced effective phacoemulsification time (EPT) compared to CPS.…”

Clinical evaluation of corneal changes after phacoemulsification in diabetic and non-diabetic cataract patients, a systematic review and meta-analysis

“…Although most cataract patients achieve decent recovery, unfortunately, in a complex disease environment, cataract surgery with phacoemulsification and lens implantation leads to larger endothelial cell loss in diabetic corneas 14 – 18 . Furthermore, the corneal endothelium can be adversely affected by surgery due to factors like lens nuclear sclerosis, effective phacoemulsification time (EPT), phacoemulsification energy, and IOL implantation 15 , 19 – 21 . These factors coupled with the effect of DM indicate a great risk of long-term endothelium cell dysfunction with decompensation and the development of bullous keratopathy 22 .…”

Phacoemulsifiction

“…There are disturbances in cell migration which results in poor healing. 10,11 Clinical and refractive outcomes of surgery vary among surgeons due to manual creation of incision and phacoemulsification. The primary outcome defining the success of surgery is the visual acuity.…”