Though further study is needed to determine conclusively whether or not femtosecond laser-assisted cataract surgery (FLACS) is associated with better refractive outcomes compared with conventional manual surgery, FLACS offers many other benefits that justify its use, according to Robert J. Cionni, MD.
“There have been numerous peer-reviewed studies and meta-analyses that failed to demonstrate refractive outcome superiority for FLACS compared with conventional cataract surgery,” said Dr. Cionni, medical director, The Eye Institute of Utah, Salt Lake City.
On the other hand, some studies demonstrated better results for FLACS in terms of quicker recovery, better refractive stability, fewer higher-order aberrations, and even in hitting the refractive target, he noted.
“There is no evidence that the refractive result is worse after FLACS, while there is evidence that FLACS creates a more precise capsulotomy, reduces ultrasound energy usage, postoperative corneal edema, and corneal endothelial cell loss,” Dr. Cionni said.
“Furthermore, FLACS does not increase the overall incidence of complications, it may be associated with a lower rate of vitreous loss, and it is immensely helpful in challenging cases, including eyes with posterior polar, brunescent or white tumescent cataract, as well as those with zonulopathy, where it can allow safe capsulotomy and reduce the need for ultrasound energy,” he added.
Speaking from experience
As a proponent for FLACS, Dr. Cionni speaks based on substantial experience. In February 2011, the first commercially available femtosecond laser installation occurred at The Eye Institute of Utah, and as of October 2016, Dr. Cionni had performed more than 2,600 FLACS procedures, counting only routine and premium cases but not more difficult, complex cases.
“FLACS now represents 35% of all of my cataract cases, and data from Market Scope and Alcon Laboratories show it has been growing worldwide,” he said.