Femtosecond laser-assisted cataract surgery: A review

Eur J Ophthalmol. 2020 May;30(3):417-429. doi: 10.1177/1120672119893291. Epub 2019 Dec 4.


Purpose: Review scientific literature concerning femtosecond laser-assisted cataract surgery.

Methods: Following databases were searched: CENTRAL (Cochrane Eyes and Vision Trials Register; Cochrane Library: Issue 2 of 12, June 2019), Ovid MEDLINE® without Revisions (1996 to June 2019), Ovid MEDLINE® (1946 to June 2019), Ovid MEDLINE® Daily Update June 2019, MEDLINE and MEDLINE Non-Indexed Items, Embase (1980-2019), Embase (1974 to June 2019), Ovid MEDLINE® and Epub Ahead of Print, in-Process & Other Non-Indexed Citations and Daily (1946 to June 2019), Web of Science (all years), the metaRegister of Controlled Trials ( www.controlled-trials.com ), ClinicalTrials.gov ( www.clinicaltrial.gov ) and World Health Organization International Clinical Trials Registry Platform ( www.who.int/ictrp/search/en ). Search terms/keywords included 'Femtosecond laser' combined with 'cataract', 'cataract surgery'.

Results: Based on quality of their methodology and their originality, 121 articles were reviewed, including randomised controlled trials, cohort studies, case-controlled studies, case series, case reports and laboratory studies. Each step of the femtosecond laser-assisted cataract surgery procedure (corneal incisions, arcuate keratotomies, capsulotomy and lens fragmentation) has been discussed with relevance to published outcomes, as well as complication rates of femtosecond laser-assisted cataract surgery, and what we can learn from the larger studies/meta-analyses and the economics of femtosecond laser-assisted cataract surgery within different healthcare settings.

Conclusion: Studies suggest that the current clinical outcomes of femtosecond laser-assisted cataract surgery are not different to conventional phacoemulsification surgery and it is not cost effective when compared with conventional phacoemulsification surgery. In its current technological form, it is a useful surgical tool in specific complex cataract scenarios, but its usage has not been shown to translate into better clinical outcomes.

Keywords: Cataract; femtosecond laser–assisted cataract surgery; phacoemulsification.

Publication types

  • Review

MeSH terms

  • Cataract / etiology*
  • Cataract Extraction* / economics
  • Cataract Extraction* / methods
  • Cost-Benefit Analysis
  • Databases, Factual
  • Humans
  • Laser Therapy / economics
  • Laser Therapy / methods*
  • Phacoemulsification / methods
  • Treatment Outcome
  • Visual Acuity / physiology