FLACS – Laser Assisted Cataract Surgery

Safer? Fact vs. Fiction

*Safety of Femtosecond Laser-Assisted Cataract Surgery (FLACS) Compared to Conventional Techniques

Summary of Evidence

Multiple high-quality studies and systematic reviews indicate that femtosecond laser-assisted cataract surgery (FLACS) is as safe as conventional phacoemulsification cataract surgery (CPCS) or manual cataract surgery (MCS), but not proven to be safer overall1 2 3 5.
Both intraoperative and postoperative complication rates are similar between FLACS and traditional methods1 3 5 10.
Some studies note FLACS-specific complications, but these are generally minor and do not affect long-term visual outcomes1 5 6.
FLACS may reduce the amount of ultrasound energy needed during surgery, which could benefit certain subgroups (e.g., patients with dense cataracts or low preoperative endothelial cell counts)5 8.
There is a learning curve with FLACS, and complication rates may be higher during initial adoption, especially among less experienced surgeons, but these rates decrease with experience6 7.

Key Findings

Overall Safety: FLACS and traditional cataract surgery have comparable safety profiles, with no significant difference in most complication rates1 2 3 5 10.
Specific Complications: Some studies report a slightly higher rate of certain complications (e.g., posterior capsular tears) with FLACS, but this is not consistent across all research, and these complications are usually minor and self-limiting1 5 10.
Visual Outcomes: Both techniques yield excellent visual and refractive results, with no significant differences in long-term outcomes2 3 5.
Special Populations: FLACS may offer benefits for patients with specific needs (e.g., dense cataracts, low endothelial cell counts), but these advantages are not universal5 8.
Cost and Practicality: FLACS is generally less cost-effective than conventional surgery and requires specialized equipment, which limits its widespread adoption3 5 8.

Conclusion

Current evidence does not support that femtosecond laser-assisted cataract surgery is safer than conventional cataract surgery. Both methods are highly safe, with similar rates of complications and excellent visual outcomes. FLACS may offer certain technical advantages in select patient populations, but it is not universally safer or more effective1 2 3 5 10.

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