Comparative study of FLACS vs conventional phacoemulsification for complex cataracts in vitrectomized eyes

Purpose: To compare the visual outcomes and complications of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification (CPS) in patients with prior pars plana vitrectomy (PPV). Setting: Department of Ophthalmology, Eye and Ears, Nose, and Throat Hospital of Fudan University, Shanghai, China. Design: Prospective randomized controlled cohort study. Method: According to the Lens Opacity Classification System III, cataract patients with nucleus grade 3 to 6 after prior PPV were randomized to 2 groups (FLACS or CPS). Endothelial cell density (ECD), central corneal thickness (CCT), and corrected distance visual acuity (CDVA) were evaluated preoperatively and at 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months postoperatively. Intraoperative parameters and intraoperative and postoperative complications were recorded. Results: 86 eyes (45 and 41 in the FLACS and CPS groups, respectively) were included and analyzed, among which 43 had hard nuclei (grade 5 or 6). Cumulative dissipated energy was lower and ultrasound time was shorter among FLACS patients with hard nuclei (P <.001). CDVA was similar in both groups at the final visit (P >.05). ECD decreased in both groups but was lower among CPS patients with hard nuclei throughout the follow-up period (P <.05). CCT had returned to preoperative levels at the final visit in both groups; however, eyes with hard cataract in the FLACS group recovered sooner. No serious complications occurred in either group. Conclusions: FLACS is beneficial in improving surgical safety and providing quicker visual rehabilitation in vitrectomized eyes with hard nuclear cataracts. Copyright (c) 2022 Published by Wolters Kluwer on behalf of ASCRS and ESCRS