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Visual and refractive outcomes and complications in femtosecond laser-assisted versus conventional phacoemulsification cataract surgery: findings from a randomised, controlled clinical trial
  1. Daliya Dzhaber1,
  2. Osama M Mustafa1,
  3. Fares Alsaleh2,
  4. Yassine J Daoud1
  1. 1Cornea, Cataract and External Diseases, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
  2. 2Ophthalmology Department, McGill University Health Centre, Montreal, Quebec, Canada
  1. Correspondence to Dr Yassine J Daoud, Wilmer Eye institute, Johns Hopkins University, Baltimore, MD 21287, USA; ydaoud1{at}


Background/aim To compare visual and refractive outcomes, changes in intraocular pressure (IOP), and complications of femtosecond laser-assisted cataract surgery (FLACS) to conventional phacoemulsification surgery (CPS) in paired eyes from the same patients.

Methods This is a secondary analysis of an intraindividual, randomised, controlled clinical trial including 110 paired eyes from 55 patients that were randomised into either FLACS or CPS groups. Outcomes were recorded at baseline and postoperatively during a 3-month follow-up period.

Results Uncorrected distance visual acuity and corrected distance visual acuity were similar between FLACS and CPS over the follow-up period (p>0.05). The mean absolute refractive error was not significantly different between the two groups at postoperative month 1 (POM1) (0.3±0.2 D in FLACS vs 0.4±0.3 D in CPS, p=0.18) and month 3 (POM3) (0.3±0.3 D in FLACS vs 0.3±0.3 D in CPS, p=0.71). IOP was statistically higher in the FLACS group on postoperative day 1 (20.6±5.7 mm Hg for FLACS and 18.0±4.9 mm Hg for CPS, p=0.01). However, it was similar between the two groups subsequently (p>0.05). Intraoperatively, one case of posterior capsular block syndrome was observed in the FLACS group. Postoperatively, one case of newly developed glaucoma was observed in the FLACS group and one case of retinal tears in the CPS group.

Conclusion The 3-month postoperative refractive and visual outcomes were comparable between FLACS and CPS in paired eyes from the same patients. Complication rate was low in the study population.

  • clinical trial
  • intraocular pressure
  • vision
  • lens and zonules

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  • DD and OMM contributed equally.

  • ——————

  • DD and OMM are joint first authors.

  • Contributors Research design: YJD; data acquisition and/or research execution: DD, FA; data analysis and/or interpretation: DD, OMM, YJD; manuscript preparation: DD, OMM, YJD; manuscript revision: DD, OMM, YJD.

  • Funding Unrestricted research grants from the Michael O’Bannon Foundation and the Turner family. Wilmer Eye Institute pooled professor fund.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Institutional review board at the Johns Hopkins University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Data are available upon reasonable request from the corresponding author.