Femto laser-assisted cataract surgery may not provide corneal benefits

This prospective study found that femtosecond laser pretreatment for cataract surgery was associated with a significant reduction in early postoperative corneal edema and endothelial cell loss compared with conventional phacoemulsification, but this difference was negligible at six months. However, laser-automated corneal incisions seemed to adversely affect corneal endothelial cells.  

The authors compared outcomes in 405 eyes that underwent femtosecond laser–assisted cataract surgery with 215 eyes that underwent conventional phaco. The initial femto cases had only capsulotomy and lens fragmentation performed with the laser, while later cases following a software upgrade also included laser corneal incisions.

Postoperative corneal edema was significantly less in the femtosecond group at one day and three weeks, but there was no difference at six months. The femto group also had significant reductions in the endothelial cell density compared with the control group at three weeks but not at six months.

Eyes in the femto group treated with laser-automated corneal incisions had greater endothelial cell loss at six months than eyes in the femto group with manual corneal incisions and eyes in the control group (P < 0.0001). Eyes in the femto group with zero effective phaco time and manually created corneal incisions had statistically significantly less endothelial cell loss at six months than the other groups (P < 0.0001).

The authors conclude that unless they can significantly reduce phaco times and avoid automated corneal incisions, femto laser is unlikely to provide a clinically significant benefit over conventional phaco cataract surgery in terms of corneal parameters.