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    This study compared the clinical outcomes of conventional phacoemulsification versus femtosecond laser-assisted cataract surgery at a single center.

    Study design

    Researchers randomized 400 eyes undergoing cataract surgery to receive either conventional phacoemulsification or femtosecond laser-assisted cataract surgery (Lensx). Patients did not pay extra for laser because all care was delivered by the National Health Service.

    The outcomes assessed included visual acuity (VA), refractive error, corneal thickness, endothelial cell loss and complication rate. Patients also took the EuroQOL 5 dimensions questionnaire (EQ-5D) and a cataract surgery patient-reported outcomes questionnaire (Cat-PROM5).

    Outcomes

    There was no statistically significant differences in uncorrected distance or pinhole VA, residual refractive error, corneal thickness, endothelial cell count or foveal thickness between groups. The rate of posterior capsule rupture (PCR), however, was lower in the femtosecond laser surgery group compared with standard surgery (0% vs. 3%; P=0.03). Seven patients in the femtosecond arm could not receive the procedure and underwent standard surgery.

    Limitations

    This study uses a small sample size, making it difficult to draw conclusions about complication rates, and the 3% PCR in this study is higher than is typically reported. Larger studies, including the randomized controlled FEMCAT trial, have failed to show lower PCR rates with use of the femtosecond laser. The authors acknowledge that the statistical analysis of PCR rates would have been insignificant with 1 additional case in the femtosecond group or 1 less case in the manual surgery group.

    Clinical significance

    This randomized controlled trial continues to show that the refractive outcomes from femtosecond laser-assisted cataract surgery are not superior to those from standard manual cataract surgery.