Study: FLACS, conventional phaco yield similar outcomes
Twelve months after treatment, there was no difference between femtosecond laser-assisted cataract surgery and conventional phacoemulsification in any parameter evaluated, one researcher told Ocular Surgery News.
However, femtosecond laser-assisted astigmatic keratotomies may provide more effective astigmatism correction than manual limbal relaxing incisions.
Nick Stanojcic, FRCOphth, and colleagues at Guy’s and St. Thomas’ NHS Foundation Trust, U.K., randomly assigned 400 patients to undergo either conventional phacoemulsication surgery or femtosecond laser-assisted cataract surgery (FLACS) using the LenSx platform (Alcon) in a single-center, prospective study. They recorded visual acuity, refraction, central corneal thickness, endothelial cell loss, adverse events and quality of life outcomes, using both EuroQOL five dimensions questionnaire and cataract surgery patient-reported outcome measures.
Overall, 234 patients completed the 12-month follow-up, including 116 in the FLACS group and 118 in the phaco group. No significant differences between the two groups in mean logMAR unaided distance visual acuity, mean spherical equivalent refraction or mean corrected distance visual acuity were identified.
Two patients in each group underwent YAG laser capsulotomy for posterior capsular opacification. Mean endothelial cell loss was 301 cells/mm2 with FLACS and 228 cells/mm2 with phaco, which was not statistically significantly different.
In a quality of life analysis, patients in the FLACS and phaco groups had similar scores.
However, in a vector analysis that compared intrastromal femtosecond laser-assisted astigmatic keratotomies and manual limbal relaxing incisions, femtosecond laser-assisted keratotomies showed greater correction index (P = .02) and smaller difference vector (P = .046).
“All major randomized controlled trials — including our own — have shown no real benefit of FLACS over conventional phacoemulsification in terms of refractive, visual or safety outcomes,” Stanojcic said. “Our RCT, however, demonstrated that intrastromal femtosecond laser-assisted keratotomies combined with FLACS may actually provide more reliable and effective astigmatism correction in patients with preexisting corneal astigmatism undergoing cataract surgery.
“By creating a perfectly predictable capsulorrhexis, FLACS technology has allowed researchers to develop new IOL designs to try and achieve better IOL centration. Femtosecond lasers have been used to mark the eye in order to achieve more accurate alignment of toric IOLs. FLACS technology has inspired a number of exciting innovations and will no doubt continue to provide us with new uses. FLACS is certainly here to stay,” he said.
- For more information:
- Nick Stanojcic, FRCOphth, can be reached at Department of Ophthalmology, Guy’s and St. Thomas’ NHS Foundation Trust, Lambeth Palace Road, London, U.K.; email: nstanojcic@doctors.org.uk.
Perspective
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Despite more than a decade of use and hundreds of published papers, there is still some controversy as to the potential advantages and disadvantages of using a femtosecond laser to assist in parts of cataract surgery. This paper is important because it is a prospective, randomized, single-center trial with experienced surgeons and patients who did not have to pay for any aspect of the cataract operation. The authors found no differences in the vision, refractive outcomes, adverse events or even patient-reported measures whether or not the femtosecond laser was used. The only difference in the group was in regard to astigmatic relaxing incisions; however, the mean corneal astigmatism was 1.4 D, and a toric IOL would have likely performed much better in this setting. For most experienced surgeons, there is no benefit to using the femtosecond laser; however, for those who find it challenging to create a capsulorrhexis or chop the nucleus, the laser can produce more consistent results in their hands.
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