Ophthalmology AdvisorNo Significant Safety Difference Between FLACS and Conventional Cataract Surgery

A meta-analysis of 17 randomized trials covering 4,466 eyes found femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification (CPCS) carry equivalent intraoperative and postoperative complication rates. Findings were presented at ASCRS 2026.

Clinical Considerations

• Overall complication rates did not differ significantly between FLACS and CPCS (P = 0.862), with consistent results across laser platforms.
• Anterior capsular rupture: 1.16% with FLACS versus 0.93% with CPCS, with no statistically significant difference.
• Posterior capsular tears trended lower with FLACS (0.85% vs 1.52%), but the difference did not reach statistical significance.
• No meaningful differences emerged in macular edema, corneal edema, 24-hour IOP spikes, or posterior capsular opacification within 12 months.

Practice Applications

• Recognize that safety is no longer a clinical differentiator between FLACS and CPCS.
• Consider patient anatomy, surgeon preference, and platform economics when selecting modality.
• Interpret marketing claims of FLACS safety advantages against the pooled randomized evidence.
• Avoid framing FLACS as inherently safer in patient counseling discussions.

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