Femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification: a literature review of refractive outcomes, surgical time, and safety
DOI:
https://doi.org/10.56183/iberojhr.v5i2.846Palavras-chave:
Femtosecond laser-assisted cataract surgery, Phacoemulsification, Refractive outcomes, Surgical efficiency, Endothelial cell loss, Cataract safety, Randomized controlled trials.Resumo
Cataract surgery, the world’s most common ophthalmic procedure, has long relied on PCS, while FLACS introduced precision and safety enhancements, though its clinical superiority and cost-effectiveness over PCS remain uncertain. A systematic search of PubMed, Cochrane Library, and Google Scholar was conducted for studies published between 2015 and 2024 using Boolean operators and keywords (“FLACS,” “phacoemulsification,” “refractive outcomes,” “surgical efficiency,” “safety”). Data were synthesized into three domains: refractive outcomes, surgical efficiency, and safety. Evidence from large RCTs (FACT, FEMCAT) and meta-analyses (>9,000 eyes) demonstrated no significant differences in refractive accuracy, with 71% of eyes in both FLACS and PCS groups achieving ±0.5 D and over 92% within ±1.0 D. Surgical efficiency analysis showed FLACS reduced cumulative dissipated energy (CDE) by 15–30% but prolonged total operative time due to docking. Safety outcomes were equivalent, with no significant increase in posterior capsule rupture or retinal complications. Early endothelial cell loss was reduced by 3–5% in FLACS groups, a benefit most relevant in high-risk patients. FLACS provides improved capsulotomy precision, reduced phaco energy use, and early corneal protection but does not confer long-term refractive or safety superiority over PCS. Its higher cost and longer operative time limit routine adoption, though it remains valuable in dense cataracts and corneal vulnerability.
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Copyright (c) 2025 Oñate Urrutia Henry Vladimir, Manuel de Jesús Joya Peña, Ana Gabriela Figueroa Ortega, Giovanni Andres Arias Audor, Luis Manuel Palacios Rodríguez, José Julián Rincón Muñoz
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