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    Assessing the impact of FLACS on surgical outcomes

    Studies have attempted to verify association between FLACS and cystoid macular oedema

    The femtosecond laser is an infrared laser with a wavelength of 1,053 nm that operates at high energy levels and very short, femtosecond range, pulses. Femtolasers, such as the Nd:YAG laser, work by producing photodisruption or photoionization of the optically transparent tissue, such as the cornea.1

     

    Femtosecond lasers were previously used primarily for corneal surgery. However, technical development enabled the first application in cataract surgery for capsulorrhexis and lens fragmentation in August 2008, which was achieved by Dr Zoltan Z. Nagy at Semmelweis University in Budapest.2 The initial results demonstrated higher precision of capsulorrhexis and reduced phacoemulsification power in porcine and human eyes.3

     

    Femtosecond lasers were believed to have revolutionised cataract surgery. However, despite the promise, the assessment of perceived benefits has proven to be far more complicated than was initially thought. In a recent review by Popovic et al.4, no statistically significant differences were detected between femtosecond laser-assisted cataract surgery (FLACS) and manual phacoemulsification cataract surgery (PCS) in terms of patient-important visual and refractive outcomes and overall complications.

     

    However, FLACS showed statistically significant differences for several secondary surgical outcomes, i.e., decreased effective phacoemulsification time; enhanced capsulotomy circularity; lower postoperative central corneal thickness; and corneal endothelial cell reduction.

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