Posters

An umbrella review comparing the safety of femtosecond laser-assisted cataract surgery with manual cataract surgery

Poster Details

First Author: Z.Nagy HUNGARY

Co Author(s):    M. Ainslie-Garcia   N. Ferko   C. Hsiao              

Abstract Details

Purpose:

Femtosecond laser-assisted cataract surgery (FLACS) automates corneal incision, capsulotomy, and lens fragmentation steps of manual cataract surgery (MCS). Although this automation can provide improved accuracy and reproducibility, which may offer advantages in safety outcomes, primary literature remains inconclusive. A narrative umbrella review of systematic reviews and meta-analyses was conducted to summarize the totality of evidence available for safety outcomes.

Setting:

Not Applicable.

Methods:

MEDLINE was searched using the terms “Femtosecond or femtolaser” and “cataract” from 2014-01-01 to 2019-11-01 for systematic reviews and meta-analyses comparing FLACS and MCS. No language restrictions were applied. Outcomes analyzed by more than one MA were extracted (corneal thickness [CT], effective phacoemulsification time [EPT] or power [EPP], endothelial cell loss [ECL], cumulative dissipated energy [CDE], anterior [ACT] or posterior capsular tears [PCT], edema, and intraocular pressure [IOP]).

Results:

The search returned 7 meta-analyses. All reviews assessing CT (n=3 meta-analyses), EPT (3) and EPP (2), found significantly more favourable outcomes for FLACS compared with MCS. FLACS was reported to reduce ECL significantly (2) or trending to significance (1). Results were mixed for CDE, ACT, PCT, edema, and IOP. The majority of meta-analyses found no difference in the rate of complications for ACT, edema, and IOP, including the review with the lowest heterogeneity. Although one meta-analysis reported significantly lower PCT with MCS, a published re-analysis of this data along with one other review found no difference.

Conclusions:

Conclusions generally favored FLACS, with good alignment between reviews. Significant heterogeneity was noted in analyses from larger reviews drawing on non-randomized trials. This research area would benefit from consistent reporting of outcomes to increase comparability within meta-analyses.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented