Comparing the Curative Effects between Femtosecond Laser-Assisted Cataract Surgery and Conventional Phacoemulsification Surgery: A Meta-Analysis

PurposeTo compare the outcomes of femtosecond laser-assisted cataract surgery (FLACS) with those of conventional phacoemulsification surgery (CPS) for age-related cataracts.MethodsA comprehensive literature search of PubMed, EMBASE, and the Cochrane Controlled Trials Register was conducted to identify randomized controlled trials (RCT) and comparative cohort studies comparing FLACS with CPS. Endothelial cell loss percentage (ECL%), central corneal thickness (CCT), corrected and uncorrected distant visual acuity (CDVA and UDVA), and mean absolute error (MAE) of refraction were used as primary outcomes. Secondary outcomes included surgically induced astigmatism (SIA), mean effective phacoemulsification time (EPT), phacoemulsification power and circularity of the capsulorhexis.ResultsNine RCTs and fifteen cohort studies including 4,903 eyes (2,861 in the FLACS group and 2,072 in the CPS group) were identified. There were significant differences between the two groups in ECL% at one week, about one month and three months postoperatively, in CCT at one day, about one month postoperatively and at the final follow-up, in CDVA at one week postoperatively, and in UDVA at the final follow-up. Significant differences were also observed in MAE, EPT, phacoemulsification power, and the circularity of capsulorhexis. However, no significant differences were observed in CDVA at one week postoperatively or in surgically induced astigmatism.ConclusionsCompared to CPS, FLACS is a safer and more effective method for reducing endothelial cell loss and postoperative central corneal thickening as well as achieving better and faster visual rehabilitation and refractive outcomes. However, there is no difference in final CDVA and surgically induced astigmatism between the two groups.

**目的** 对比飞秒激光辅助白内障手术（femtosecond laser-assisted cataract surgery, FLACS）与常规超声乳化白内障吸除术（conventional phacoemulsification surgery, CPS）治疗年龄相关性白内障的临床结局。
**方法** 系统检索PubMed、EMBASE及Cochrane对照试验注册库，筛选对比FLACS与CPS的随机对照试验（randomized controlled trials, RCT）及比较性队列研究。以角膜内皮细胞丢失率（endothelial cell loss percentage, ECL%）、中央角膜厚度（central corneal thickness, CCT）、矫正远视力（corrected distant visual acuity, CDVA）、未矫正远视力（uncorrected distant visual acuity, UDVA）及屈光平均绝对误差（mean absolute error, MAE）作为主要结局指标；次要结局指标包括手术源性散光（surgically induced astigmatism, SIA）、平均有效超声乳化时间（mean effective phacoemulsification time, EPT）、超声乳化能量及撕囊口圆度。
**结果** 共纳入9项随机对照试验及15项队列研究，涉及4903只眼（FLACS组2861只眼，CPS组2072只眼）。两组患者术后1周、约1个月及3个月的角膜内皮细胞丢失率，术后1天、约1个月及末次随访时的中央角膜厚度，术后1周的矫正远视力，以及末次随访时的未矫正远视力差异均具有统计学意义；两组在屈光平均绝对误差、平均有效超声乳化时间、超声乳化能量及撕囊口圆度方面亦存在统计学差异。不过，两组患者末次随访的矫正远视力与手术源性散光差异无统计学意义。
**结论** 与CPS相比，FLACS可更安全有效地减少角膜内皮细胞丢失及术后中央角膜厚度增厚，同时可获得更佳、更快的视觉康复效果与屈光预后。不过，两组患者末次随访的矫正远视力及手术源性散光差异无统计学意义。