Abstract
Purpose of Review
To summarize current evidence on the safety of cataract surgery with and without the femtosecond laser
Recent Findings
Large studies, including a government-financed randomized controlled trial, have consistently failed to demonstrate any additional safety benefit from femtosecond laser–assisted cataract surgery (FLACS) when compared to manual phaco. Additional high-quality studies, such as the European Society for Cataract and Refractive Surgery EUREQUO FLACS Study, suggest that manual cataract surgery actually has fewer complications. The data on whether FLACS reduces endothelial cell count loss are mixed. Similarly, proof of a significant improvement in refractive outcomes from FLACS has not been demonstrated.
Summary
Although individual surgeon preferences for FLACS may continue, current evidence shows that it is at best noninferior to standard manual cataract surgery. Given the additional costs associated with use of FLACS, ophthalmologists discussing this technology with patients should take care not to overstate its potential benefits.
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References
American Academy of Ophthalmology & American Society of Cataract and Refractive Surgery. Guidelines on billing Medicare beneficiaries when using the femtosecond laser. 2012. Available at http://ascrs.org/sites/default/files/resources/12-04-2012%20FS%20Laser%20Guidelines%20Document%20 (2)_0.pdf.
Abell RG, Davies PE, Phelan D, Goemann K, McPherson ZE, Vote BJ. Anterior capsulotomy integrity after femtosecond laser-assisted cataract surgery. Ophthalmology. 2014;121(1):17–24. https://doi.org/10.1016/j.ophtha.2013.08.013.
Ewe SY, Abell RG, Oakley CL, Lim CH, Allen PL, McPherson ZE, et al. A comparative cohort study of visual outcomes in femtosecond laser-assisted versus phacoemulsification cataract surgery. Ophthalmology. 2016;123(1):178–82. https://doi.org/10.1016/j.ophtha.2015.09.026.
Berk TA, Schlenker MB, Campos-Moller X, Pereira AM, Ahmed IIK. Visual and refractive outcomes in manual versus femtosecond laser-assisted cataract surgery: a single-center retrospective cohort analysis of 1838 eyes. Ophthalmology. 2018. https://doi.org/10.1016/j.ophtha.2018.01.028.
Takagi M, Kojima T, Ichikawa K, Tanaka Y, Kato Y, Horai R, et al. Comparison of maximum stretch forces between femtosecond laser-assisted capsulotomy and continuous curvilinear capsulorhexis. J Ophthalmol. 2017;2017:3489373. https://doi.org/10.1155/2017/3489373.
Abell RG, Kerr NM, Howie AR, Mustaffa Kamal MA, Allen PL, Vote BJ. Effect of femtosecond laser-assisted cataract surgery on the corneal endothelium. J Cataract Refract Surg. 2014;40(11):1777–83. https://doi.org/10.1016/j.jcrs.2014.05.031.
Yu Y, Chen X, Hua H, Wu M, Lai K, Yao K. Comparative outcomes of femtosecond laser-assisted cataract surgery and manual phacoemusification: a six-month follow-up. Clin Exp Ophthalmol. 2016;44(6):472–80. https://doi.org/10.1111/ceo.12695.
Yesilirmak N, Diakonis VF, Sise A, Waren DP, Yoo SH, Donaldson KE. Differences in energy expenditure for conventional and femtosecond-assisted cataract surgery using 2 different phacoemulsification systems. J Cataract Refract Surg. 2017;43(1):16–21. https://doi.org/10.1016/j.jcrs.2016.11.037.
Chen X, Yu Y, Song X, Zhu Y, Wang W, Yao K. Clinical outcomes of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery for hard nuclear cataracts. J Cataract Refract Surg. 2017;43(4):486–91. https://doi.org/10.1016/j.jcrs.2017.01.010.
Titiyal JS, Kaur M, Singh A, Arora T, Sharma N. Comparative evaluation of femtosecond laser-assisted cataract surgery and conventional phacoemulsification in white cataract. Clin Ophthalmol. 2016;10:1357–64. https://doi.org/10.2147/opth.s108243.
Chee SP, Wong MH, Jap A. Management of severely subluxated cataracts using femtosecond laser-assisted cataract surgery. Am J Ophthalmol. 2017;173:7–15. https://doi.org/10.1016/j.ajo.2016.09.021.
Abell RG, Darian-Smith E, Kan JB, Allen PL, Ewe SY, Vote BJ. Femtosecond laser-assisted cataract surgery versus standard phacoemulsification cataract surgery: outcomes and safety in more than 4000 cases at a single center. J Cataract Refract Surg. 2015;41(1):47–52. https://doi.org/10.1016/j.jcrs.2014.06.025.
Diakonis VF, Yesilirmak N, Sayed-Ahmed IO, Warren DP, Kounis GA, Davis Z, et al. Effects of femtosecond laser-assisted cataract pretreatment on pupil diameter: a comparison between three laser platforms. J Refract Surg. 2016;32(2):84–8. https://doi.org/10.3928/1081597x-20,151,229-03.
Jun JH, Hwang KY, Chang SD, Joo CK. Pupil-size alterations induced by photodisruption during femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2015;41(2):278–85. https://doi.org/10.1016/j.jcrs.2014.10.027.
Yu Y, Hua H, Wu M, Yu Y, Yu W, Lai K, et al. Evaluation of dry eye after femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2015;41(12):2614–23. https://doi.org/10.1016/j.jcrs.2015.06.036.
Manning S, Barry P, Henry Y, Rosen P, Stenevi U, Young D, et al. Femtosecond laser-assisted cataract surgery versus standard phacoemulsification cataract surgery: Study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg. 2016;42(12):1779–90. https://doi.org/10.1016/j.jcrs.2016.10.013.
Popovic M, Campos-Moller X, Schlenker MB, Ahmed II. Efficacy and safety of femtosecond laser-assisted cataract surgery compared with manual cataract surgery: a meta-analysis of 14567 eyes. Ophthalmology. 2016;123(10):2113–26. https://doi.org/10.1016/j.ophtha.2016.07.005.
Scott WJ, Tauber S, Gessler JA, Ohly JG, Owsiak RR, Eck CD. Comparison of vitreous loss rates between manual phacoemulsification and femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2016;42(7):1003–8. https://doi.org/10.1016/j.jcrs.2016.04.027.
Schweitzer C on behalf of the. Six years on: is FLACS a better and safer operation than phaco?: evidence from the French FEMCAT study. ESCRS; Oct. 11, 2017; Lisbon 2017.
Panthier C, Costantini F, Rigal-Sastourne JC, Brezin A, Mehanna C, Guedj M, et al. Change of capsulotomy over 1 year in femtosecond laser-assisted cataract surgery and its impact on visual quality. J Refract Surg. 2017;33(1):44–9. https://doi.org/10.3928/1081597x-20,161,028-01.
Haque M, Jabbour S, Fadlallah A, Harissi-Dagher M, Chelala E, Melki S. Integrity of intrastromal arcuate keratotomies performed by femtosecond laser. J Refract Surg. 2016;32(1):67–8. https://doi.org/10.3928/1081597x-20,151,207-02.
Wang L, Jiang L, Hallahan K, Al-Mohtaseb ZN, Koch DD. Evaluation of Femtosecond laser intrastromal incision location using optical coherence tomography. Ophthalmology. 2017;124(8):1120–5. https://doi.org/10.1016/j.ophtha.2017.03.022.
Zhu S, Qu N, Wang W, Zhu Y, Shentu X, Chen P, et al. Morphologic features and surgically induced astigmatism of femtosecond laser versus manual clear corneal incisions. J Cataract Refract Surg. 2017;43(11):1430–5. https://doi.org/10.1016/j.jcrs.2017.08.011.
Diakonis VF, Yesilirmak N, Cabot F, Kankariya VP, Kounis GA, Warren D, et al. Comparison of surgically induced astigmatism between femtosecond laser and manual clear corneal incisions for cataract surgery. J Cataract Refract Surg. 2015;41(10):2075–80. https://doi.org/10.1016/j.jcrs.2015.11.004.
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David Chang has the following relevant financial interests: Mynosys, Iantech, J&J Vision, RxSight. Bryan Lee reports personal fees from Allergan, personal fees from New World Medical, personal fees from Katena, outside the submitted work.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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This article is part of the Topical Collection on Cataract
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Lee, B.S., Chang, D.F. Femtosecond Laser-Assisted Cataract Surgery vs. Phacoemulsification: Overall Safety and the Effect on the Corneal Endothelium. Curr Ophthalmol Rep 6, 245–248 (2018). https://doi.org/10.1007/s40135-018-0192-1
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DOI: https://doi.org/10.1007/s40135-018-0192-1