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ESCRS FLACS study update: More postop complications with femto than phaco

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BARCELONA — The updated European Society of Cataract and Refractive Surgeons study on femtosecond laser-assisted cataract surgery finds that “femto does not outperform phaco,” according to Peter Barry, MD, who delivered this year’s results.

Although the ESCRS FLACS study found the femtosecond procedure to result in significantly better outcomes in terms of postoperative and surgically induced astigmatism, postoperative complications outnumbered those of phaco surgery, leading to a significantly higher percentage of patients with worse visual acuity than before surgery, Barry said at the ESCRS meeting.

Peter Barry

A total of 2,814 prospective FLACS cases since December 2013 were gathered from 16 centers in 10 countries in Europe. Controls were selected retrospectively from the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) following rigorous matching criteria.

“Perioperative complications were more frequent with femto, but not when you excluded femto-specific complications such as inability to dock and various capsular problems,” Barry said.

The overall number of postoperative surgical complications was significantly higher, with more cases of corneal edema, early posterior capsule opacification reducing visual acuity and uveitis requiring treatment.

Although the percentage of patients whose vision improved was equal in the two groups, these complications explain why “a striking 3.3% of patients in the femto group lost lines of vision compared to 1.3% in the phaco group,” Barry said.

In regard to postoperative astigmatism, the femtosecond procedure showed advantages. The ratio of patients with cylinder of 1.5 D or greater was 18.5% in the phaco group and 9% in the femtosecond laser group.

“This improvement is still maintained if you remove patients receiving toric IOLs, concurrent femto-refractive surgery and previous corneal refractive surgery,” Barry said.

Postoperative surgically induced astigmatism was also significantly lower with femtosecond laser. — by Michela Cimberle

Disclosure: Barry reports no relevant financial disclosure.