Flacs Vs Phaco In The Real World: Difficulty Graded Intraoperative Complication Rates In A High Volume Service

To compare intraoperative complication rates between femtosecond laser–assisted cataract surgery (FLACS) and phacoemulsification (PHACO; MICS merged with PHACO) in a high‑volume real‑world setting, stratified by cataract difficulty grade. 

Multisite high‑volume cataract program, calendar year 2025, routinely captured electronic surgical dataset.

Retrospective cohort analysis. Surgeries were grouped as FLACS or PHACOEMULSIFICATION. Cataract difficulty grading used the recorded Group 1/2/3 field and mapped to G1/G2/G3. Intraoperative outcomes were derived from standard complication fields; any intraoperative complication was defined as “No complication” not marked, and PCR was defined as PCR with or without vitreous disturbance. Results are descriptive with grade‑stratified rates. 

A total of 443 FLACS and 193,336 PHACO cases were analysed. Case‑mix by grade for FLACS was G1 n=169, G2 n=257, G3 n=12 (PHACO: G1 n=89,035, G2 n=92,996, G3 n=9,793).
Overall, any intraoperative complication occurred in 0.90% of FLACS (4/443) vs 0.92% of PHACO (1,785/193,336). PCR occurred in 0.90% of FLACS (4/443; PCR with vitreous disturbance 2/443, without 2/443) vs 0.76% of PHACO (1,463/193,336; with vitreous disturbance 644/193,336, without 819/193,336). Non‑PCR intraoperative complications were 0% in FLACS (0/443) vs 0.17% in PHACO (322/193,336)

In this high‑volume dataset, overall intraoperative complication rates were similar between FLACS and PHACO.