Is Femtosecond Laser-Assisted Cataract Surgery A Favorable Choice? An Updated Meta-Analysis Of 50 Randomized Controlled Trials With Trial Sequential Analysis
Published 2024 - 42nd Congress of the ESCRS
Reference: PP12.09 | Type: Poster | DOI: 10.82333/yh6v-pm55
Authors: Shang-Yen Wu* 1 , Jen-Hung Wang 2 , Cheng-Jen Chiu 3
1Department of Ophthalmology,Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation,Hualien City,Taiwan, Province of China, 2Department of Medical Research,Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation,Hualien City,Taiwan, Province of China, 3Department of Ophthalmology,Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation,Hualien City,Taiwan, Province of China;Department of Ophthalmology and Visual Science,Tzu Chi University,Hualien City,Taiwan, Province of China
Purpose
To compare the efficacy, safety, and patient-reported outcomes of femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification cataract surgery (CPCS).
Setting
Efficacy and Safety of FLACS Compared with CPCS.
Methods
A systematic search/analysis of PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov up to January 2023 was conducted without date/language restrictions. Weighted mean differences, risk ratios, and Hedges’ g with 95% confidence intervals were calculated. The stability of results was assessed using trial sequential analysis (TSA). Registration No. PROSPERO CRD42023393323.
Results
Fifty randomized controlled trials revealed that FLACS yielded a significantly better CDVA 1 week postoperatively, with no significant differences in CDVA beyond 1 week, or in uncorrected distance visual acuity, spherical equivalent, or surgically induced astigmatism. No significant differences were observed in overall complications. These findings were supported by TSA, where the cumulative Z curve of CDVA, UDVA, and overall complications intersected the futility boundaries. CPCS yielded significantly lower PGE2 levels and total prostaglandin levels, except when NSAIDs were used. Ultimately, the overall complications, patient-reported health, visual, and daily-activity outcomes were not significantly different between FLACS and CPCS.
Conclusions
In conclusion, we identified no substantial disparities in long-term visual acuity, complications, or patient-reported outcomes between FLACS and CPCS. Subgroup analysis showed consistent efficacy and safety across diverse laser platforms. Notably, FLACS exhibited no clear cost-effectiveness advantage over CPCS.