**5.2 Refractive outcomes**

### *5.2.1 Distance visual acuity*

The clinical comparative studies performed on a selected series of cases have failed to demonstrate any statistical significance of FLACS versus conventional phacoemulsification surgery concerning the visual outcomes, the intraocular lens power predictability, the corrected distance visual acuity (CDVA) and the uncorrected distance visual acuity (UDVA). Some studies reported better CDVA, UDVA and intraocular lens power predictability for FLACS, while others have reported no differences. In all cases, the 12-month post-operative visual acuity is high. The mean CDVA was 0.03 logMAR, range of −0.08 to 0.05 logMAR [2, 13, 32]. Superiority of UDVA in has been reported at 2 hours, 3 days,

**31**

*Femto Laser-Assisted Cataract Surgery*

*DOI: http://dx.doi.org/10.5772/intechopen.88821*

logMAR, range 0.07 to 0.23 [32, 34].

**5.3 Post-operative and long-term complications**

*5.3.1 Anterior segment inflammation and flare*

regarding retinal thickness after 3 months.

*5.3.2 Late capsulorhexis decentration*

*5.3.3 Vitreoretinal complications*

*5.3.4 Elevated intraocular pressure*

**5.4 Cost and resource use**

femtosecond procedures has been described.

significant elevated IOP was observed after FLACS [39].

surgery seems equal, considering all complications.

procedure [37].

and 1 week postoperatively. After 1 month and later, no statistically significant differences between groups are shown [16]. The mean long-term UDVA was 0.13

Two studies demonstrated that postoperative aqueous flare was significantly greater in eyes that had undergone manual cataract surgery at 1 day and at 4 weeks postoperatively than in eyes after FLACS [35, 36] without significant differences

Compared with manual capsulorhexis, there is evidence of advantages with FLACS by obtaining a more precise shape and size of capsulotomy [22]. This should be associated with a better intraocular lens centration, and then potentially less intraocular lens tilt. However, femtosecond laser capsulotomy shape changes over time and does not improve visual acuity compared with the manual

Clinical cystoid macular edema (CME) after cataract surgery, manual or FLACS, remains a rare complication with a prevalence lower than 2% [2]. The peri-operative use of nonsteroidal drops may interfere with the CME rate. Endophthalmitis, expulsive hemorrhage and retinal detachment are rarer complications, estimated at less than 0.1% [38]. No difference between manual phacoemulsification and

The FLACS procedure induces a transient increase of intra-ocular pressure (IOP), during the suction phase, higher with flat and curved applanating contact interfaces compared with the fluid-filled interface. In the 2 years follow-up, no

In summary, the rate of intra-operative and post-operative complications remains low, less than 2% and not statistically different between FLACS and manual phacoemulsification [40]. Although anterior and posterior capsule tears could have been a concern, the safety of FLACS and phacoemulsification cataract

Costs related to FLACS have been much higher than with the conventional procedure so far. It can represent a barrier to wider acceptance by surgeons and clinical centers. This may be difficulty to adopt as more functional benefits have not been yet clearly established with this new technology. An extra-cost of approximately USD 500 to USD 600 per operated eye is associated with FLACS (approximately USD 400,000 for the device, plus USD 150 to 300 for disposables per procedure). However, these elements may vary dramatically among

*Eyesight and Imaging - Advances and New Perspectives*

• Verify the eye's centration (avoid tilting)

• Evacuate the air bubble before hydrodissection • Gentle hydrodissection and slow nucleus rotation • Lens removal: Phaco-chop more than Divide and Conquer

• Verify complete capsulotomy

posterior corneal folds. Laser induced miosis can be managed by adding 0.5% tropicamide drops in the liquid filled into the patient interface. We have not seen capsular blockage syndrome as we gently rock the nucleus to remove the gas bubbles trapped into the capsule before performing hydrodissection. We recommend the hydrodissection to be soft but complete. Phacoemulsification is easier after laser treatment but should be performed cautiously by the beginner. All the fragment patterns among the different devices effectively cut the nucleus and allow for easy disassembly. The ice-cube pattern available with the Victus is for us the more efficient pattern, as the surgeon only has to separate the first ice cubes to quickly remove all the nucleus.

In conclusion, FLACS increases the ease and predictability of the steps involved

By using a laser to fragment the crystalline lens, less US energy is required to complete its removal. The reduction in the effective phako time can reach 70% and

Lower endothelial cell loss with the laser-assisted procedure compared with the manual phacoemulsification has been reported in the early post-operative state due to the reduction of EPT, with the LensX, the LensAR, the Catalys, and the Victus

The clinical comparative studies performed on a selected series of cases have failed to demonstrate any statistical significance of FLACS versus conventional phacoemulsification surgery concerning the visual outcomes, the intraocular lens power predictability, the corrected distance visual acuity (CDVA) and the uncorrected distance visual acuity (UDVA). Some studies reported better CDVA, UDVA and intraocular lens power predictability for FLACS, while others have reported no differences. In all cases, the 12-month post-operative visual acuity is high. The mean CDVA was 0.03 logMAR, range of −0.08 to 0.05 logMAR [2, 13, 32]. Superiority of UDVA in has been reported at 2 hours, 3 days,

zero phacoemulsification time is possible in nearly 50% of operations [13].

in cataract surgery but has a surgical learning curve and most of the complications occur during the first 100 procedures [19]. Greater surgeon experience and improved technology are associated with a significant reduction in complications.

Most complications are predictable and largely preventable.

• Cortex removal: Easier if the posterior lens off-set is small (800 μm)

**5. Safety and efficacy of FLACS**

**5.1 Intraocular energy delivered**

TIPS FOR SUCCESS

platforms [33].

**5.2 Refractive outcomes**

*5.2.1 Distance visual acuity*

**30**

and 1 week postoperatively. After 1 month and later, no statistically significant differences between groups are shown [16]. The mean long-term UDVA was 0.13 logMAR, range 0.07 to 0.23 [32, 34].
