Assessing The Learning Curve Of A Young Surgeon: Outcomes And Challenges In The First 20 Cases Of Femtosecond Laser-Assisted Cataract Surgery (Flacs)

To evaluate the operative challenges, surgical efficiency, and complication patterns during a novice surgeon’s first 20 FLACS procedures.

A single-center, observational study was conducted at VISTA Eye Specialist, Malaysia, by a single surgeon.

Twenty consecutive FLACS cases performed by a recently trained FLACS surgeon using the Ziemer LDV Z8 machine were evaluated. Common FLACS-related issues, such as incomplete capsulotomy, capsule-related complications, laser docking efficiency, and phacoemulsification parameters (ultrasound power, effective phacoemulsification time), were documented if present. The primary outcome was overall complication incidence; secondary outcomes included surgical efficiency and surgeon confidence trends over the 20-case series.

All cases proceeded without the need for re-docking of the Ziemer Z8 cone. One incomplete capsulotomy and one minor radial anterior capsule tear were observed. Two patients experienced intraoperative miosis. Mean ultrasound power and phacoemulsification time remained unchanged throughout. All surgeries were uncomplicated, and intraocular lenses were successfully implanted in the capsular bag.

Femtosecond laser-assisted cataract surgery (FLACS) proved safe and feasible for a surgeon transitioning from conventional phacoemulsification. Early challenges primarily involved device handling and capsulotomy integrity. Surgical outcomes were comparable to conventional phacoemulsification. Close mentorship, careful patient selection, and gradual refinements in technique supported rapid improvements in both efficiency and safety.