Femtosecond laser-assisted cataract surgery (FLACS) has some benefits for patients and for surgeons, but it remains to be seen if it adds value when used in combined glaucoma-cataract procedures, said Leon W. Herndon Jr., MD.
“Most glaucoma patients are appropriate candidates for FLACS, and FLACS can make cataract surgery easier,” said Dr. Herndon, professor of ophthalmology, Duke University School of Medicine, Hillsborough, NC. “Overall, FLACS has been shown to be safe, and it is growing rapidly. The question remains, however, whether glaucoma surgeons should be making the leap.”
The femtosecond laser can be used in cataract surgery for corneal incisions, capsulotomy, and lens pre-treatment, Dr. Herndon noted. Its use has advantages for customizing the procedure; providing a live OCT of the anterior segment; improving capsulotomy size, shape, and centration; reducing ultrasound energy use through lens pre-treatment; and creating precise arcuate incisions for astigmatism treatment.
The effects of FLACS on surgical outcomes is controversial. Results of a recently published multicenter case-control study from Europe, which included 2,814 FLACS cases and 4,987 eyes undergoing conventional cataract surgery, reported no difference between groups in refractive outcomes or intraoperative complications [Manning S, et al. J Cataract Refract Surg. 2016;42:1779-1790].
However, the incidence of postoperative corrected distance visual acuity (CDVA) worse than preoperative was higher in the FLACS group and could be explained by more postoperative corneal edema, early posterior capsule opacification, and uveitis in the FLACS group.
“One issue to be aware of when performing FLACS is that cortex removal can be more challenging,” Dr. Herndon said.