Femtosecond Laser-Assisted Cataract Surgery vs. Phacoemulsification: Overall Safety and the Effect on the Corneal Endothelium
Purpose of Review
To summarize current evidence on the safety of cataract surgery with and without the femtosecond laser
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.
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.
KeywordsPhacoemulsification Cataract surgery Femtosecond laser Femtosecond laser–assisted cataract surgery
Compliance with Ethical Standards
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.
- 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.
- 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.
- 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.CrossRefGoogle 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.CrossRefGoogle 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.CrossRefGoogle 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.CrossRefGoogle 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.Google Scholar
- 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.CrossRefGoogle 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.CrossRefGoogle Scholar