Clinical outcomes and complications between FLACS and conventional phacoemulsification cataract surgery: a PRISMA-compliant Meta-analysis of 25 randomized controlled trials

AIM: To update and investigate the clinical outcomes and complications between femtosecond laser-assisted cataract surgery(FLACS) and conventional phacoemulsification cataract surgery(CPCS). METHODS: A Meta-analysis was performed using databases, including Pubmed, Embase, and the Cochrane library. At least one of the clinical outcomes and/or complications data in each included randomized controlled trials(RCT) was reported. The quality of the RCT was assessed with the Cochrane risk assessments tool.RESULTS: Overall, 25 RCTs including 3781 eyes were included. No statistically significant difference detected between FLACS and CPCS in terms of corrected distant visual acuity(CDVA), uncorrected distant visual acuity(UDVA), and central corneal thickness(CCT) at the longterm follow up, although FLACS showed better CDVA at 1 wk postoperatively, and less increase in CCT at 1 d and 1 wk. FLACS had better postoperative endothelial cell count(ECC) at 1 and 4-6 wk, while there was no significantly difference between FLACS and CPCS at 1 d, 3 and 6 mo [weighted mean difference(WMD): 51.54, 95% confidence interval(CI):-5.46 to 108.54, P=0.08;WMD: 48.52, 95%CI:-17.54 to 114.58, P=0.15;WMD: 12.17, 95%CI:-48.61 to 72.94, P=0.69, respectively]. Postoperative endothelial cell loss(ECL) of the FLACS was significantly lower than that of the CPCS at 1, 4-6 wk, and 3 mo(P=0.02, 0.008, 0.03, respectively). However, there was no significant difference between two groups at 6 mo(WMD:-30.36, 95%CI:-78.84 to 18.12, P=0.22). No significant difference was discovered with respect to the macular edema [odds ratio(OR): 0.93, 95%CI: 0.42 to 2.05, P=0.85], capsular complication excluding posterior capsular tears(OR: 0.79, 95%CI: 0.42 to 1.50, P=0.47) and intraocular pressure change(OR: 0.82, 95%CI: 0.39 to 1.72, P=0.60). However, posterior capsular tears were more common in CPCS group(OR: 0.12, 95%CI: 0.01 to 0.98, P=0.05). The effective phacoemulsification times were significantly lower in the FLACS group compared to the CPCS group(WMD:-0.78, 95%CI:-1.23 to-0.34, P=0.0006).CONCLUSION: No statistically significant difference is discovered between FLACS and CPCS in clinical outcomes at the long-term follow up. However, higher rate of posterior capsular tears is detected in patients receiving CPCS.

Safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract:A meta-analysis and systematic review

Purpose:To compare the complications of femtosecond laser-assisted cataract surgery(FLACS)with those of conventional phacoemulsification surgery(CPS)for age-related cataracts.Methods:PubMed,Cochrane Library,and EMBASE were systematically searched for studies comparing FLACS and CPS.Outcomes were operative complications,including the intraoperative capsule tear,postoperative corneal edema,macular edema,uncontrolled IOP,etc.The effect measures were weighted with odds ratios with 95%CIs.Results:Nineteen RCTs and 18 cohort studies,including 24,806 eyes(11,375 of the FLACS group and 13,431 of the CPS group),were identified.There were no significant differences between the two groups in anterior capsule tear,corneal edema,macular edema,uncontrolled IOP,vitreous loss,posterior vitreous detachment,etc.Posterior capsule tear rate showed a significantly lower in RCT subgroups(P=0.04)and without differences in total(P=0.63).Significant differences were observed in the incidence of descemet membrane tear/trauma(P=0.02)and IFIS/iris trauma(P=0.04.Additionally,The FLACS specific complications showed a significantly higher rate of miosis(P=0.0001),corneal epithelial defect(P=0.001),corneal haze(P=0.002),and subconjunctival hemorrhage(P=0.01).Conclusions:FLACS maintains the same safety compared with CPS in terms of all intraoperative and postoperative complications.Although FLACS did show a statistically significant difference for several FLACS specific complications,it would not influence the visual outcome and heal itself.