FEMTOSECOND LASER-ASSISTED CATARACT SURGERY VERSUS STANDARD PHACOEMULSIFICATION CATARACT SURGERY: COCHRANE REVIEW UPDATE

Femtosecond laser platforms that can accurately and reproducibly perform key steps in cataract surgery. Our aim was to compare the safety and effectiveness of femtosecond laser-assisted cataract surgery (FLACS) with standard ultrasound phacoemulsification cataract surgery (PCS) by gathering evidence from randomised controlled trials (RCTs).

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 5); Ovid MEDLINE; Ovid Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov; the WHO ICTRP and the U.S. Food and Drugs Administration (FDA) website.  We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 10 May 2022.

We included RCTs where FLACS was compared to PCS. The certainty of the evidence was graded using GRADE. Two review authors independently screened the search results, assessed risk of bias and extracted data using the standard methodological procedures expected by Cochrane. The primary outcome was intraoperative complications and main secondary outcomes were postoperative complications, visual acuity and quality of life.

We included 42 RCTs conducted that enrolled a total of 7298 eyes of 5831 adult participants. Overall, the studies were at unclear or high risk of bias. There was moderate-certainty evidence of little or no difference in the risk of developing most intraoperative or postoperative complications comparing FLACS and PCS. However, we found evidence that FLACS halves the risk of developing posterior capsular tears compared to PCS. The risk of posterior capsular tears was 8 in 1000 in the PCS arm and 4 in 1000 in the FLACS arm. We also found moderate-certainty evidence of little or no difference in most postoperative visual acuity measurements between FLACS and PCS. At 6 months or more follow-up, there was moderate-certainty evidence of a very small advantage for the FLACS for corrected distance visual acuity. This difference is equivalent to 1 logMAR letter between groups and is not clinically significant.

The evidence from the 42 RCTs included in this review suggests that FLACS may carry a lower risk of posterior capsular tears than PCS. Beyond this, there is probably little or no difference comparing PCS and FLACS in terms of most intraoperative and postoperative complications, postoperative visual acuity and quality of life.