Efficacy and safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract: a meta-analysis of randomized controlled trials

Xiaoyun Chen, Wei Xiao, Shaobi Ye, Weirong Chen, Yizhi Liu, Xiaoyun Chen, Wei Xiao, Shaobi Ye, Weirong Chen, Yizhi Liu

Abstract

The aim of this study was to evaluate the efficacy and safety of femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification cataract surgery (CPCS) in the treatment of cataract. Randomized controlled trials (RCTs) were searched in PubMed, Embase and the Cochrane Central Register of Controlled Trials. Nine qualified studies with a total of 989 eyes were included. Compared with CPCS, FLACS significantly reduced mean phaco energy and effective phacoemulsification time (EPT) required in the surgery. Central corneal thickness (CCT) was significantly lower in FLACS at 1 day of follow-up, but CCT and corneal endothelial cells count was comparable at 1 week of follow-up or longer. FLACS achieved a better visual outcome at postoperative 1 week and 6 months, but the difference was not significant at postoperative 1-3 months. Regard to surgical complications, the incidences of intraoperative anterior capsule tear, postoperative macular edema and elevated intraocular pressure were similar. In conclusion, femtosecond laser pretreatment can reduce phaco energy and EPT, which may reduce the heat damage to ocular tissues by ultrasound. This novel technique might be beneficial for patients with dense cataract and/or low preoperative endothelial cell values. Well-designed RCTs with longer follow-up are still necessary to provide more reliable evidence.

Figures

Figure 1. Flow chart of literature search…
Figure 1. Flow chart of literature search and study selection.
Figure 2. Forest plots displaying the effect…
Figure 2. Forest plots displaying the effect of FLACS versus CPCS on uncorrected distance visual acuity (UDVA) at postoperative 1 week, 1 month and 6 months.
Figure 3. Forest plot exhibiting the effect…
Figure 3. Forest plot exhibiting the effect of FLACS versus CPCS on corrected distance visual acuity (CDVA) at postoperative 1 week, 1–3 months and 6 months.
Figure 4
Figure 4
(a) Forest plots showing the effect of FLACS versus CPCS on the corneal endothelial cell counts at postoperative 1 week and 4–6 weeks. (b) Forest plots displaying the effect of FLACS versus CPCS on the central corneal thickness (CCT) at postoperative 1 day and 1 week.
Figure 5
Figure 5
Forest plots revealing the effect of FLACS versus CPCS on mean phaco energy (a), mean phaco time (b), and effective phaco time (EPT) used in the surgery.
Figure 6
Figure 6
(a) Forest plots representing the effect of FLACS versus CPCS on the circularity of capsulorrhexis at postoperative 1 week. (b) Forest plots showing the incidences of intraoperative and postoperative complications in FLACS versus CPCS.

References

    1. Uy H. S., Edwards K. & Curtis N. Femtosecond phacoemulsification: the business and the medicine. Curr Opin Ophthalmol 23, 33–39 (2012).
    1. Devgan U. Surgical techniques in phacoemulsification. Curr Opin Ophthalmol 18, 19–22 (2007).
    1. Zeng M. et al. Torsional ultrasound modality for hard nucleus phacoemulsification cataract extraction. Br J Ophthalmol 92, 1092–1096 (2008).
    1. Hoffman R. S., Fine I. H. & Packer M. New phacoemulsification technology. Curr Opin Ophthalmol 16, 38–43 (2005).
    1. Georgescu D., Kuo A. F., Kinard K. I. & Olson R. J. A fluidics comparison of Alcon Infiniti, Bausch & Lomb Stellaris, and Advanced Medical Optics Signature phacoemulsification machines. Am J Ophthalmol 145, 1014–1017 (2008).
    1. Bourne R. R. et al. Effect of cataract surgery on the corneal endothelium: modern phacoemulsification compared with extracapsular cataract surgery. Ophthalmology 111, 679–685 (2004).
    1. Lundstrom M. et al. Capsule complication during cataract surgery: Background, study design, and required additional care: Swedish Capsule Rupture Study Group report 1. J Cataract Refract Surg 35, 1679–1687 e1671 (2009).
    1. Yonekawa Y. & Kim I. K. Pseudophakic cystoid macular edema. Curr Opin Ophthalmol 23, 26–32 (2012).
    1. Ho T. T., Kaiser R. & Benson W. E. Retinal complications of cataract surgery. Compr Ophthalmol Update 7, 1–10 (2006).
    1. Clark A. et al. Quality of life after postoperative endophthalmitis. Clin Experiment Ophthalmol 36, 526–531 (2008).
    1. He L., Sheehy K. & Culbertson W. Femtosecond laser-assisted cataract surgery. Curr Opin Ophthalmol 22, 43–52 (2011).
    1. Ranka M. & Donnenfeld E. D. Femtosecond laser will be the standard method for cataract extraction ten years from now. Surv Ophthalmol 60, 356–360 (2015).
    1. Conrad-Hengerer I., Al Juburi M., Schultz T., Hengerer F. H. & Dick H. B. Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser-assisted cataract surgery: Three-month follow-up. J Cataract Refract Surg 39, 1307–1313 (2013).
    1. Abell R. G., Kerr N. M. & Vote B. J. Toward zero effective phacoemulsification time using femtosecond laser pretreatment. Ophthalmology 120, 942–948 (2013).
    1. Abell R. G., Kerr N. M. & Vote B. J. Femtosecond laser-assisted cataract surgery compared with conventional cataract surgery. Clin Experiment Ophthalmol 41, 455–462 (2013).
    1. Conrad-Hengerer I., Hengerer F. H., Schultz T. & Dick H. B. Effect of femtosecond laser fragmentation on effective phacoemulsification time in cataract surgery. J Refract Surg 28, 879–883 (2012).
    1. Reddy K. P., Kandulla J. & Auffarth G. U. Effectiveness and safety of femtosecond laser-assisted lens fragmentation and anterior capsulotomy versus the manual technique in cataract surgery. J Cataract Refract Surg 39, 1297–1306 (2013).
    1. Takacs A. I. et al. Central corneal volume and endothelial cell count following femtosecond laser-assisted refractive cataract surgery compared to conventional phacoemulsification. J Refract Surg 28, 387–391 (2012).
    1. Mastropasqua L. et al. Femtosecond laser versus manual clear corneal incision in cataract surgery. J Refract Surg 30, 27–33 (2014).
    1. Abell R. G. et al. Effect of femtosecond laser-assisted cataract surgery on the corneal endothelium. J Cataract Refract Surg 40, 1777–1783 (2014).
    1. Moshirfar M., Churgin D. S. & Hsu M. Femtosecond laser-assisted cataract surgery: a current review. Middle East Afr J Ophthalmol 18, 285–291 (2011).
    1. Friedman N. J. et al. Femtosecond laser capsulotomy. J Cataract Refract Surg 37, 1189–1198 (2011).
    1. Kranitz K. et al. Intraocular lens tilt and decentration measured by scheimpflug camera following manual or femtosecond laser-created continuous circular capsulotomy. J Refract Surg 28, 259–263 (2012).
    1. Assia E. I., Apple D. J., Tsai J. C. & Morgan R. C. Mechanism of radial tear formation and extension after anterior capsulectomy. Ophthalmology 98, 432–437 (1991).
    1. Feldman B. H. Femtosecond laser will not be a standard method for cataract extraction ten years from now. Surv Ophthalmol 60, 360–365 (2015).
    1. Filkorn T. et al. Comparison of IOL power calculation and refractive outcome after laser refractive cataract surgery with a femtosecond laser versus conventional phacoemulsification. J Refract Surg 28, 540–544 (2012).
    1. Ecsedy M. et al. Effect of femtosecond laser cataract surgery on the macula. J Refract Surg 27, 717–722 (2011).
    1. Krarup T., Holm L. M., La Cour M. & Kjaerbo H. Endothelial cell loss and refractive predictability in femtosecond laser-assisted cataract surgery compared with conventional cataract surgery. Acta Ophthalmol 92, 617–622 (2014).
    1. Abell R. G. et al. Anterior capsulotomy integrity after femtosecond laser-assisted cataract surgery. Ophthalmology 121, 17–24 (2014).
    1. Daya S. M., Nanavaty M. A. & Espinosa-Lagana M. M. Translenticular hydrodissection, lens fragmentation, and influence on ultrasound power in femtosecond laser-assisted cataract surgery and refractive lens exchange. J Cataract Refract Surg 40, 37–43 (2014).
    1. Conrad-Hengerer I., Hengerer F. H., Al Juburi M., Schultz T. & Dick H. B. Femtosecond laser-induced macular changes and anterior segment inflammation in cataract surgery. J Refract Surg 30, 222–226 (2014).
    1. Nagy Z. Z. et al. Comparison of intraocular lens decentration parameters after femtosecond and manual capsulotomies. J Refract Surg 27, 564–569 (2011).
    1. Mastropasqua L. et al. Optical coherence tomography and 3-dimensional confocal structured imaging system-guided femtosecond laser capsulotomy versus manual continuous curvilinear capsulorhexis. J Cataract Refract Surg 40, 2035–2043 (2014).
    1. Hatch K. M. & Talamo J. H. Laser-assisted cataract surgery: benefits and barriers. Curr Opin Ophthalmol 25, 54–61 (2014).
    1. Hollick E. J., Spalton D. J. & Meacock W. R. The effect of capsulorhexis size on posterior capsular opacification: one-year results of a randomized prospective trial. Am J Ophthalmol 128, 271–279 (1999).
    1. Norrby S. Sources of error in intraocular lens power calculation. J Cataract Refract Surg 34, 368–376 (2008).
    1. Bali S. J., Hodge C., Lawless M., Roberts T. V. & Sutton G. Early experience with the femtosecond laser for cataract surgery. Ophthalmology 119, 891–899 (2012).
    1. Mentes J., Erakgun T., Afrashi F. & Kerci G. Incidence of cystoid macular edema after uncomplicated phacoemulsification. Ophthalmologica 217, 408–412 (2003).
    1. Biro Z., Balla Z. & Kovacs B. Change of foveal and perifoveal thickness measured by OCT after phacoemulsification and IOL implantation. Eye (Lond) 22, 8–12 (2008).
    1. Saldanha I. J., Dickersin K., Wang X. & Li T. Outcomes in Cochrane systematic reviews addressing four common eye conditions: an evaluation of completeness and comparability. PloS one 9, e109400 (2014).
    1. Hozo S. P., Djulbegovic B. & Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5, 13 (2005).

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