Intra and post-operative complications observed with femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery: a systematic review and meta-analysis

BMC Ophthalmol. 2019 Aug 9;19(1):177. doi: 10.1186/s12886-019-1190-2.


Background: In this analysis, we aimed to systematically compare the complications which were associated with femtosecond laser-assisted cataract surgery (FLACS) versus the conventional phacoemulsification surgery (CPE).

Methods: Commonly used search databases, specifically MEDLINE, Cochrane Central, EMBASE, and were carefully searched for English publications comparing FLACS versus CPE. The selected endpoints which were assessed included incomplete capsulotomy, anterior capsulotomy tag, anterior capsule tear, posterior capsule tear, injury to the descemet's membrane, zonular dialysis, vitreous loss, macular or corneal edema, and elevated intra-ocular pressure. Statistical analysis was carried out by the latest version of the RevMan software (version 5.3) and represented by risk ratios (RR) with 95% confidence intervals (CI).

Results: A total number of 7156 participants were included. Three thousand five hundred and fifty four (3554) participants were assigned to the FLACS group. The risks for incomplete capsulotomy, anterior capsulotomy tag, and anterior capsular tear were significantly higher with FLACS (RR: 22.42, 95% CI: 4.53-110.82; P = 0.0001), (RR: 33.07, 95% CI: 6.53-167.56; P = 0.0001) and (RR: 4.74, 95% CI: 2.59-8.68; P = 0.00001) respectively. The risks for macular/corneal edema (RR: 2.05, 95% CI: 1.18-3.55; P = 0.01) and elevated intra-ocular pressure (RR: 3.24, 95% CI: 1.55-6.78; P = 0.002) were also significantly higher with FLACS. However, the risks for impaired descemet's membrane (RR: 0.95, 95% CI: 0.61-1.47; P = 0.80), zonular dialysis (RR: 0.40, 95% CI: 0.06-2.72; P = 0.35), vitreous loss (RR: 0.09, 95% CI: 0.01-1.63; P = 0.10) and posterior capsular tear (RR: 1.45, 95% CI: 0.23-9.16; P = 0.69) were not significantly different.

Conclusions: The current results showed that FLACS did not improve intra/post-operative complications in comparison to CPE. Further larger studies should confirm this hypothesis.

Keywords: Conventional phacoemulsification surgery; Femtosecond laser-assisted cataract surgery; Post-operative complications.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Cataract Extraction / adverse effects*
  • Humans
  • Intraoperative Complications*
  • Laser Therapy / adverse effects*
  • Phacoemulsification / adverse effects
  • Postoperative Complications*
  • Visual Acuity*