Abstract
Purpose :
The corneal endothelium plays an integral role in regulating stromal hydration which affects the transparency of the cornea. Phacoemulsification energy has been demonstrated to result in endothelial loss and femtosecond laser-assisted cataract surgery (FLACS) has been proposed to reduce endothelial damage compared to conventional phacoemulsification (CP) by reducing the amount of energy required. However, FLACS is more than twice as costly as CP and increases operating theatre utilization time. Therefore, it is crucial to demonstrate a benefit with FLACS. This meta-analysis aims to evaluate the corneal endothelial and visual outcomes of FLACS compared to CP.
Methods :
A systematic literature search was performed on PubMed, EMBASE, and Cochrane library in May 2022. Two reviewers independently selected studies against inclusion and exclusion criteria. Patients with pre-existing corneal endothelial compromise or other ocular diseases were excluded. Statistical analysis was performed on R version 4.2.1 and Hedge’s g was used to evaluate effect size. Outcome parameters investigated include endothelial cell count, hexagonality, coefficient of variation, corneal thickness, visual acuity, duration of surgery and effective phacoemulsification time.
Results :
A total of 429 abstracts were reviewed and data from 14 studies (2383 eyes) were included. On specular microscopy, FLACS mildly reduced endothelial cell loss compared to CP (Hedge’s g = 0.26, (95% CI 0.05 to 0.46)) and resulted in a higher coefficient of variation (Hedge’s g = 0.54 (95% CI 0.30 to 0.78)). No significant difference was found across other outcomes relating to corneal endothelium and visual acuity. Shorter operating duration was significant in CP compared to FLACS (Hedge’s g = 0.57 (95% CI 0.11 to 1.03)), although heterogeneity should be considered (I2 = 92.3%).
Conclusions :
Despite marginal superiority in corneal endothelial outcomes for FLACS, no difference was noted in visual outcomes and other measured parameters. The long-term implication of these findings remains uncertain and further longitudinal studies need to be performed to address the role of FLACS vis-a-vis its associated economic and healthcare costs.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.