The Latest Evidence with Regards to Femtosecond Laser-Assisted Cataract Surgery and Its Use Post 2020

Abstract

Femtosecond laser-assisted cataract surgery (FLACS) was introduced with the hope of making cataract surgery safer and making the refractive result more predictable. It is only in the last four years that level 1 prospective randomised controlled trials (RCT) using current technology have been published. These, along with a meta-analysis of recent studies have shown that there seems to be little long-term visual benefit when using FLACS with monofocal lenses. The promised decrease in ultrasound energy required to remove a cataract has not been consistently demonstrated. There is level one evidence that the rate of posterior capsular rupture is less with FLACS using modern software. The round capsulotomy may be of increasing importance with the uptake of toric, multifocal and extended depth of focus lenses where a predictable capsulotomy size and precise placement of the lens becomes more important.

Recent developments in anterior capsulotomy for cataract surgery

“…A similar study in 100 eyes found no significant differences in refractive outcomes after surgery [34]. A 2021 review of articles comparing FLACS and manual surgery concluded that there was little difference between the techniques for monofocal lens implantation but suggested that FLACS might still be useful for toric, multifocal, and extended depth of field lenses where 'predictable capsulotomy size and precise placement of the lens becomes more important' [35].…”