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Heather Chen, Thomas Hyatt, Natalie A Afshari; Femtosecond laser cataract surgery versus phacoemulsification: a meta-analysis of visual and refractive outcomes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4182.
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To compare the visual and refractive outcomes of femtosecond laser cataract surgery (FLCS) versus standard phacoemulsification cataract surgery, a meta-analysis of published studies reporting visual outcomes of femtosecond laser cataract surgery was conducted. We compared post-operative visual acuity and refractive outcomes between patients who underwent FLCS and patients who received standard phacoemulsification.
Two hundred eighteen articles were retrieved from Medline and cross-reference searches. Articles with sufficient original data comparing post-operative visual acuity and/or mean absolute error between a group of femtosecond cases and a group of control phacoemulsification cases were included in the analysis. Articles that did not perform in-study controls and reviews without original data were excluded. The standardized mean difference for visual acuity and mean absolute error were calculated using a random-effects model. Meta-regression analysis to assess heterogeneity was performed. This meta-analysis involved 785 eyes: 469 operated by femtosecond laser, 316 by standard phacoemulsification. The main outcome measures were post-operative best-corrected distance visual acuity and mean absolute error (absolute difference between predicted and achieved post-operative spherical equivalent refraction).
Of 218 papers, six matched inclusion criteria. In a subgroup of four papers, there was no statistically significant difference in post-operative best-corrected visual acuity between the femtosecond and control groups (p = 0.3555, 95% CI). From another subgroup of four papers, the post-operative mean absolute error was found to be statistically equivalent between the two groups (p = 0.4354, 95% CI).
A meta-analysis of current published literature suggests that visual acuity and refractive outcomes of femtosecond laser are statistically equivalent to those of conventional phacoemulsification surgery at this time. However, the learning curve involved with laser use may account for these early results, which could improve with time. We anticipate that in the next few years, a surge in femtosecond laser cataract surgeries performed will yield more helpful data to broaden our understanding. Further long-term outcomes studies are needed in order to better evaluate the impact of femtosecond lasers on patient outcomes and quality of cataract surgery.
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