TITLE:
Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification for Dense Cataracts: A Systematic Review and Meta-Analysis
AUTHORS:
Marcelo Ramos, Lucas M. Barbosa, Sofia de Melo Ramos, Luisa de Melo Ramos, Orlando Daniel Quintanar Haro, Regis Ponte Conrado, Maria Antônia Costa Cruz Akabane, Gustavo Carlos Heringer
KEYWORDS:
Dense Cataract, FLACS, Meta-Analysis, Phacoemulsification
JOURNAL NAME:
Open Journal of Ophthalmology,
Vol.15 No.4,
November
25,
2025
ABSTRACT: Topic: Femtosecond-laser-assisted cataract surgery (FLACS) compared to conventional phacoemulsification surgery (CPS) in dense cataracts. Clinical Relevance: FLACS is a novel approach to cataract removal, offering potential advantages over CPS. Although these two techniques have been previously studied in patient populations with cataracts, their comparative efficacy in dense cataracts is still unknown. Methods: We systematically searched PubMed, Embase, and Cochrane Library for studies reporting visual and surgical outcomes of FLACS versus CPS in patients with dense cataracts. Patients were followed up for one month for outcomes of effective phacoemulsification time (EPT), cumulative dissipated energy (CDE), endothelial cell density (ECD), central corneal thickness (CCT), and % ECD loss. Data were pooled using weighted mean differences (MD) with 95% confidence intervals (CI) in random-effects model. All statistical analyses were conducted using R Studio version 4.4.1. Results: Our meta-analysis included 19 studies comprising a pooled population of 5433 eyes, of which 2315 (42.6%) were allocated to CPS group. The mean age ranged from 55.2 to 79.1 years. Compared to CPS, FLACS significantly reduced the EPT (MD 2.92 seconds; 95% CI −5.23 to −0.61; p = 0.013) and CDE (MD −3.23 J; 95% CI −5.11 to −1.34; p 2; 95% CI—93.52 to 241.77; p = 0.39), CCT (MD 1.11 um; 95 % CI—19.53 to 21.76; p = 0.92), and % ECD loss (MD—5.26%; 95% CI—22.34 to 11.83; p = 0.55). Conclusion: In this systematic review and meta-analysis of patients with dense cataracts, FLACS was associated with a reduction in EPT and CDE as compared with CPS, with no significant change in ECD, CCT, and %ECD loss.