Femtosecond laser–assisted cataract surgery: A review

Purpose: Review scientific literature concerning femtosecond laser–assisted cataract surgery. Methods: Following databases were searched: CENTRAL (Cochrane Eyes and Vision Trials Register; Cochrane Library: Issue 2 of 12, June 2019), Ovid MEDLINE® without Revisions (1996 to June 2019), Ovid MEDLINE® (1946 to June 2019), Ovid MEDLINE® Daily Update June 2019, MEDLINE and MEDLINE Non-Indexed Items, Embase (1980–2019), Embase (1974 to June 2019), Ovid MEDLINE® and Epub Ahead of Print, in-Process & Other Non-Indexed Citations and Daily (1946 to June 2019), Web of Science (all years), the metaRegister of Controlled Trials ( www.controlled-trials.com ), ClinicalTrials.gov ( www.clinicaltrial.gov ) and World Health Organization International Clinical Trials Registry Platform ( www.who.int/ictrp/search/en ). Search terms/keywords included ‘Femtosecond laser’ combined with ‘cataract’, ‘cataract surgery’. Results: Based on quality of their methodology and their originality, 121 articles were reviewed, including randomised controlled trials, cohort studies, case-controlled studies, case series, case reports and laboratory studies. Each step of the femtosecond laser–assisted cataract surgery procedure (corneal incisions, arcuate keratotomies, capsulotomy and lens fragmentation) has been discussed with relevance to published outcomes, as well as complication rates of femtosecond laser–assisted cataract surgery, and what we can learn from the larger studies/meta-analyses and the economics of femtosecond laser–assisted cataract surgery within different healthcare settings. Conclusion: Studies suggest that the current clinical outcomes of femtosecond laser–assisted cataract surgery are not different to conventional phacoemulsification surgery and it is not cost effective when compared with conventional phacoemulsification surgery. In its current technological form, it is a useful surgical tool in specific complex cataract scenarios, but its usage has not been shown to translate into better clinical outcomes.