Clarification needed on the effects of FLACS

The authors of a new review in Current Opinion in Ophthalmology advocate for more research to clarify the short- and long-term effects of femtosecond laser-assisted cataract surgery (FLACS) on the corneal endothelium.

FLACS may reduce endothelial cell loss, they write, but the reduction most likely occurs only in the early postoperative period. Research to date has reached varying conclusions on FLACS’ ability to reduce endothelial cell loss, the authors note. Some studies point to the reduced amount of ultrasound energy required with FLACS. Others show no difference or less cell loss with FLACS than with standard phacoemulsification 1 to 3 months postoperatively. At 6 months, however, some studies have found that cell loss is similar regardless of technique used.

Further, newer advancements in surgical technique or technology - biaxial microincision surgery, the use of ultraviolet light in light-adjustable IOLs, and newer viscous - dispersives, for instance - show cell loss rates that are similar to or better than standard phaco.

“Viscous dispersives may offer equal or increased protection of the corneal endothelium during surgery compared with viscoelastic devices currently in wide use, but further studies are required to support these results,” they add.