Lee Ssu-Hsien, Chiu Yu-Chieh, Tsai Ping-Chiao, Wang Jen-Hung, Chiu Cheng-Jen
School of Medicine, Tzu Chi University, Hualien, 970, Taiwan.
Medical Administration Office, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan.
Sci Rep. 2025 Jul 29;15(1):27569. doi: 10.1038/s41598-025-13174-1.
The study aims to compare the efficacy/safety of femtosecond laser-assisted cataract surgery (FLACS) vs. conventional phacoemulsification cataract surgery (CPCS). A systematic search/analysis of PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov up to January 2023 was conducted without date/language restrictions. Weighted mean differences, risk ratios, and Hedges' g with 95% confidence intervals were calculated. The stability of results was assessed using trial sequential analysis (TSA). International Prospective Register of Systematic Reviews Registration No. PROSPERO CRD42023393323. Forty-six randomized controlled trials (8,871 eyes) revealed that FLACS yielded a significantly better corrected distance visual acuity (CDVA) 1 week postoperatively (P = 0.011) with no significant differences in CDVA beyond 1 week (P = 0.161, 0.429, 0.403), or in uncorrected distance visual acuity (P = 0.171, 0.136, 0.322, 0.149), spherical equivalent, or surgically induced astigmatism. Concerning safety outcomes, no significant differences were observed in overall complications (P = 0.999). These findings were supported by TSA. Ultimately, the overall complications, patient-reported health, visual, and daily-activity outcomes were not significantly different between FLACS and CPCS. Regarding extended-term and patient-centered outcomes, we identified no substantial disparities in visual acuity, complications, or patient-reported outcomes between FLACS and CPCS. Subgroup analysis showed consistent efficacy and safety across diverse laser platforms. Notably, FLACS exhibited no clear cost-effectiveness advantage over CPCS.
本研究旨在比较飞秒激光辅助白内障手术（FLACS）与传统超声乳化白内障手术（CPCS）的疗效/安全性。对截至2023年1月的PubMed、Embase、Cochrane CENTRAL和ClinicalTrials.gov进行了系统检索/分析，无日期/语言限制。计算加权平均差、风险比和95%置信区间的Hedges' g。使用试验序贯分析（TSA）评估结果的稳定性。国际系统评价前瞻性注册库注册号PROSPERO CRD42023393323。46项随机对照试验（8871只眼）显示，FLACS术后1周的矫正远视力（CDVA）明显更好（P = 0.011），1周后CDVA无显著差异（P = 0.161、0.429、0.403），未矫正远视力（P = 0.171、0.136、0.322、0.149）、球镜等效度或手术诱导散光也无显著差异。关于安全性结果，总体并发症方面未观察到显著差异（P = 0.999）。这些发现得到了TSA的支持。最终，FLACS和CPCS在总体并发症、患者报告的健康、视力和日常活动结果方面无显著差异。关于长期和以患者为中心的结果，我们发现FLACS和CPCS在视力、并发症或患者报告的结果方面没有实质性差异。亚组分析显示，不同激光平台的疗效和安全性一致。值得注意的是，FLACS与CPCS相比没有明显的成本效益优势。
