15 EyeWorld Asia-Pacific | December 2024 Source: Ke Yao, MD will become less important. Moreover, FLACS requires specialized equipment maintenance and learning curve for surgeons, which may diminish its advantages.8 Besides, FLACS resulted in higher risk of postoperative fluorescein staining and dry eye symptoms,9 caused more SIA than manually created corneal incisions, which could have resulted from inaccurate or uncertain corneal incision positioning of the femtosecond machine.10 With ongoing technological advancements, the future of FLACS is promising. Continued optimization and individualization of surgical parameters could further reduce complication rates and shorten operative times, improving vision restoration. The integration of FLACS with other emerging technologies, such as optical coherence tomography (OCT) and artificial intelligence (AI) could enhance surgical precision, automate processes, and improve safety. Numerous studies have systematically evaluated FLACS. Femtosecond laser-assisted cataract surgery has demonstrated substantial clinical advantages over conventional phacoemulsification surgery in recent years. FLACS offers improved precision, reduced complication rates, and faster postoperative recovery, especially in complex cases like hard nuclear cataracts and high myopia.11-13 While cost and technical challenges remain, FLACS is likely to become a dominant cataract surgery method in the future, especially for refractive cataract surgery.14 References 1. Yu, Y., et al., Comparative outcomes of femtosecond laser-assisted cataract surgery and manual phacoemusification: a six-month follow-up. Clin Exp Ophthalmol, 2016. 44(6): p. 472-80. 2. Zhang, X., et al., Performance of femtosecond laser-assisted cataract surgery in Chinese patients with cataract: a prospective, multicenter, registry study. BMC Ophthalmol, 2019. 19(1): p. 77. 3. Zhong, Y., et al., Femtosecond laser-assisted cataract surgery versus conventional phacoemulsification: comparison of internal aberrations and visual quality. Graefes Arch Clin Exp Ophthalmol, 2022. 260(3): p. 901-911. 4. Chen, X., et al., Clinical outcomes of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery for hard nuclear cataracts. J Cataract Refract Surg, 2017. 43(4): p. 486-491. 5. Lyu, D., et al., Comparison of Perioperative Parameters in Femtosecond Laser-Assisted Cataract Surgery Using 3 Nuclear Fragmentation Patterns. Am J Ophthalmol, 2020. 213: p. 283-292. 6. Zhu, Y., et al., Parameters of Capsulorrhexis and Intraocular Lens Decentration After Femtosecond and Manual Capsulotomies in High Myopic Patients With Cataracts. Front Med (Lausanne), 2021. 8: p. 640269. 7. Zhu, Y., et al., Lens capsule-related complications of femtosecond laser-assisted capsulotomy versus manual capsulorhexis for white cataracts. J Cataract Refract Surg, 2019. 45(3): p. 337-342. 8. Zhang, X., et al., Incidence and analysis of intraoperative complications in femtosecond laser-assisted cataract surgery: a large-scale cohort study to establish the learning curve. Br J Ophthalmol, 2024. 9. Yu, Y., et al., Evaluation of dry eye after femtosecond laser-assisted cataract surgery. J Cataract Refract Surg, 2015. 41(12): p. 2614-23. 10. Zhu, S., et al., Morphologic features and surgically induced astigmatism of femtosecond laser versus manual clear corneal incisions. J Cataract Refract Surg, 2017. 43(11): p. 1430-1435. 11. Wang, H., et al., Comparison of femtosecond laser-assisted cataract surgery and conventional phacoemulsification on corneal impact: A meta-analysis and systematic review. PLoS One, 2023. 18(4): p. e0284181. 12. Xu, J., et al., Safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract: A meta-analysis and systematic review. Adv Ophthalmol Pract Res, 2022. 2(1): p. 100027. 13. Chen, X., et al., Comparing the Curative Effects between Femtosecond Laser-Assisted Cataract Surgery and Conventional Phacoemulsification Surgery: A Meta-Analysis. PLoS One, 2016. 11(3): p. e0152088. 14. Chen, X., et al., Cataract: Advances in surgery and whether surgery remains the only treatment in future. Adv Ophthalmol Pract Res, 2021. 1(1): p. 100008. About the Physicians Nic Reus, MD, PhD, FEBOS-CR | Breda, The Netherlands, Molengracht 21, 4811 CK | nreus@amphia.nl Ke Yao, MD | Chief & Professor, Zhejiang University Eye Hospital Eye Center, Second Affiliated Hospital Zhejiang University School of Medicine | xlren@zju.edu.cn Relevant Disclosures Reus: Alcon, Johnson & Johnson, and Zeiss Yao: None FEATURE Pathways to Precision and Perfection – Phaco vs. Femto
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