Skip to main content

Advertisement

Log in

Femtosecond Laser-Assisted Cataract Surgery vs. Phacoemulsification: Overall Safety and the Effect on the Corneal Endothelium

  • Cataract (CE Starr and A Brissette, Section Editors)
  • Published:
Current Ophthalmology Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. 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.

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

  5. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bryan S. Lee.

Ethics declarations

Conflict of Interest

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.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Cataract

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40135-018-0192-1

Keywords

Navigation