Femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification in cataract management: a systematic review
FLACS vs. PCS in cataract management
DOI:
https://doi.org/10.59747/smjidisurabaya.v2i2.88Abstract
Background: Cataracts remain the leading cause of reversible blindness and visual impairment worldwide. While phacoemulsification surgery (PCS) remains a highly effective and safe procedure, its success can be influenced by associated complications. Femtosecond laser-assisted cataract surgery (FLACS) has emerged as an alternative, offering greater safety, efficacy, and predictability, particularly for complex cataracts. Objective: This study aims to compare FLACS with PCS to evaluate differences in outcomes such as uncorrected distance visual acuity (UDVA), best-corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss (ECL), and intraoperative complications. Materials and Methods: Following PRISMA guidelines, a systematic review was conducted. Studies published between 2015 and 2021 were identified through databases including PubMed, ScienceDirect, and Cochrane Library. Included studies involved cataract patients undergoing either FLACS or PCS, with outcomes measured for visual acuity, corneal cell integrity, and surgical complications. Results: FLACS demonstrated faster recovery in UDVA and BCVA within the initial postoperative period compared to PCS, although visual acuity results were similar by three to 12 months. While short-term endothelial preservation was similar, FLACS was associated with slightly higher long-term ECL, suggesting that PCS may better preserve corneal health over time. Complications such as anterior capsule tears were more frequent in FLACS. However, serious events were rare across both groups. FLACS yielded more precise corneal incisions, which may contribute to more stable wound healing during the early recovery stage. Conclusion: FLACS offers advantages in early postoperative visual recovery. However, PCS may provide slightly better long-term endothelial preservation. Both techniques ultimately result in similar visual outcomes in the long term, with FLACS presenting unique yet manageable intraoperative risks
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