Efficacy and Safety of Femtosecond Laser-Assisted Cataract Surgery Compared with Manual Cataract Surgery: A Meta-Analysis of 14 567 Eyes

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• 作者：Marko Popovic ; MD(C)¹ ; Xavier Campos-Mö ; ller ; MD² ; ³ ; Matthew B. Schlenker ; MD² ; ³ ; Iqbal Ike K. Ahmed ; MD ; FRCSC² ; ³ ; ⁴ ; ^{ike.ahmed@utoronto.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：CCI ; clear corneal incision ; CDE ; cumulative dissipated energy ; CDVA ; corrected distance visual acuity ; CI ; confidence interval ; EUREQUO ; European Registry of Quality Outcomes for Cataract and Refractive Surgery ; FLACS ; femtosecond laser-assisted cataract surgery ; IOL ; intraocular lens ; IOP ; intraocular pressure ; logMAR ; logarithm of the minimum angle of resolution ; MAE ; mean absolute error ; MCS ; manual cataract surgery ; NOS ; Newcastle-Ottawa Quality Assessment Scale ; RR ; relative risk ; UDVA ; un
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：123
• 期：10
• 页码：2113-2126
• 全文大小：4003 K

文摘

To investigate the efficacy and safety of femtosecond laser-assisted cataract surgery (FLACS) relative to manual cataract surgery (MCS).

Clinical Relevance

It is unclear whether FLACS is more efficacious and safe relative to MCS.

Methods

A literature search of MEDLINE, EMBASE, and Scopus from 2007 to March 2016 was conducted. Studies containing both FLACS and MCS arms that reported on relevant efficacy and/or safety parameters were included. Weighted mean differences (WMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.

Results

From 2802 screened articles, 14 567 eyes from 15 randomized controlled trials and 22 observational cohort studies were included. For primary visual and refractive outcomes, no statistically significant difference was detected between FLACS and MCS in uncorrected distance visual acuity (WMD, −0.02; 95% CI, −0.04 to 0.01; P = 0.19), corrected distance visual acuity (WMD, −0.01; 95% CI, −0.02 to 0.01; P = 0.26), and mean absolute error (WMD, −0.02; 95% CI, −0.07 to 0.04; P = 0.57). In terms of secondary surgical end points, there was a statistically significant difference in favor of FLACS over MCS for effective phacoemulsification time (WMD, −3.03; 95% CI, −3.80 to −2.25; P < 0.001), capsulotomy circularity (WMD, 0.16; 95% CI, 0.11–0.21; P < 0.001), postoperative central corneal thickness (WMD, −6.37; 95% CI, −11.88 to −0.86; P = 0.02), and corneal endothelial cell reduction (WMD, −55.43; 95% CI, −95.18 to −15.69; P = 0.006). There was no statistically significant difference between FLACS and MCS for total surgery time (WMD, 1.25; 95% CI, −0.08 to 2.59; P = 0.07), capsulotomy circularity using a second formula (WMD, 0.05; 95% CI, −0.01 to 0.12; P = 0.10), and corneal endothelial cell count (WMD, 73.39; 95% CI, −6.28 to 153.07; P = 0.07). As well, there was a significantly higher concentration of prostaglandins after FLACS relative to MCS (WMD, 198.34; 95% CI, 129.99–266.69; P < 0.001). Analysis of safety parameters revealed that there were no statistically significant differences in the incidence of overall complications between FLACS and MCS (RR, 2.15; 95% CI, 0.74 to 6.23; P = 0.16); however, posterior capsular tears were significantly more common in FLACS versus MCS (RR, 3.73; 95% CI, 1.50–9.25; P = 0.005).

Conclusions

There were no statistically significant differences detected between FLACS and MCS in terms of patient-important visual and refractive outcomes and overall complications. Although FLACS did show a statistically significant difference for several secondary surgical outcomes, it was associated with higher prostaglandin concentrations and higher rates of posterior capsular tears.