Purpose: To compare the efficacy and safety of femtosecond laser-assisted cataract surgery (FLACS) with conventional cataract surgery (CCS).
Setting: Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany.
Methods: PubMed, Cochrane Library, and EMBASE were systematically searched for studies comparing FLACS and CCS. Outcomes were efficacy and safety parameters. The effect measures were weighted mean differences or odds ratios with 95% CIs.
Results: A total of 73 studies (25 randomized controlled, 48 observational) were reviewed with a total of 12 769 eyes treated with FLACS and 12 274 eyes treated with CCS. In eyes treated with FLACS, uncorrected and corrected distance visual acuities and spherical equivalent after 1 month to 3 months (P = .04, P = .005, and P = .007, respectively) were better, total and effective phacoemulsification times were shorter (P < .001 each), cumulative dissipated energy was less (P < .001), circularity was more accurate (P < .001), central corneal thickness after 1 day and 1 month to 3 months was less (P < .001 and P = .004, respectively), and endothelial cell loss after 3 to 6 weeks and 3 months was less (P = .002 and P < .001, respectively) compared with CCS. Anterior capsule ruptures occurred more often with FLACS. No significant differences among groups were found in visual acuity at 1 week and after 6 months or in posterior capsule rupture rates and endothelial cell loss after 6 months.
Conclusions: Both FLACS and CCS are effective and safe. FLACS required less ultrasound energy and a more precise treatment. However, mid-term visual acuity did not show any difference between both methods.