Femtosecond laser-assisted cataract surgery versus conventional phacoemulsification: Refractive and aberrometric outcomes with a diffractive multifocal intraocular lens

J Cataract Refract Surg. 2019 Jan;45(1):21-27. doi: 10.1016/j.jcrs.2018.08.032. Epub 2018 Nov 10.


Purpose: To compare the outcomes of conventional phacoemulsification and femtosecond laser-assisted cataract surgery followed by multifocal intraocular lens (IOL) implantation.

Setting: Asan Medical Center, Seoul, South Korea.

Design: Retrospective case series.

Methods: Depending on their preference, patients had femtosecond laser-assisted cataract surgery or conventional phacoemulsification. Patients in the femtosecond group with corneal astigmatism greater than 0.75 diopter also had arcuate keratotomy. All eyes had multifocal IOL implantation. One month after treatment, the uncorrected distance and near visual acuities, spherical equivalent, corneal and refractive astigmatism, aberrometry results, and questionnaire results were compared between groups. Correlations between target-induced astigmatism (TIA) and surgically induced astigmatism (SIA) were also compared between the groups.

Results: The femtosecond group comprised 17 patients (23 eyes), with arcuate keratotomy performed in 14 eyes. The conventional phacoemulsification group comprised 22 patients (26 eyes). In the femtosecond group, the difference in corneal astigmatism between preoperatively and postoperatively was statistically significant. The correlation between TIA and SIA was greater in the femtosecond group. Corneal root-mean-square higher-order aberrations (RMS HOAs) (P < .01) and total trefoil (P = .043) were significantly higher in the femtosecond laser group. However, internal total RMS (P = .05), tilt (P = .041), and RMS HOAs (P = .047) were significantly lower in the femtosecond group. Satisfaction scores were significantly higher in the femtosecond group.

Conclusions: Astigmatic change was more predictable in the femtosecond laser-assisted cataract surgery group. Internal aberrations, including total RMS, tilt, and RMS HOAs, were lower in the femtosecond group, and patients in that group were more satisfied.

Publication types

  • Comparative Study

MeSH terms

  • Aberrometry
  • Adult
  • Aged
  • Aged, 80 and over
  • Astigmatism / physiopathology
  • Cataract Extraction / methods*
  • Corneal Wavefront Aberration / physiopathology*
  • Female
  • Humans
  • Laser Therapy / methods*
  • Lens Implantation, Intraocular*
  • Male
  • Middle Aged
  • Multifocal Intraocular Lenses*
  • Patient Satisfaction
  • Phacoemulsification / methods*
  • Pseudophakia / physiopathology
  • Refraction, Ocular / physiology
  • Retrospective Studies
  • Surveys and Questionnaires
  • Visual Acuity / physiology
  • Young Adult