Aug 2026· Indian Journal of Ophthalmology· 0 citations
Medicine
TL;DR
FLACS demonstrated faster and more complete recovery of corneal sensitivity by 90 days, but this neurosensory advantage may be particularly relevant for patients predisposed to ocular surface dysfunction.
Abstract
Objective
To compare early postoperative changes in central corneal sensitivity following conventional phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS).
Methods
This prospective two-arm cohort study included 74 patients (148 eyes) with age-related cataract who underwent either phacoemulsification (88 eyes) or FLACS (60 eyes) performed by a single surgeon between July 2024 and March 2025. Central corneal sensitivity was measured using a Cochet-Bonnet esthesiometer preoperatively and at 30 and 90 days. Outcome assessors were masked to the surgical technique. Propensity score matching and generalized estimating equations were applied to adjust for baseline differences and within-patient correlation. The primary endpoint was sensitivity at 90 days adjusted for baseline.
Results
Baseline sensitivity was slightly higher in FLACS eyes (46.08 ± 8.87 mm) compared with phacoemulsification (42.63 ± 7.18 mm, P = 0.012). At 30 days, both groups demonstrated significant reductions from baseline (P < 0.001), with no significant intergroup difference. By 90 days, sensitivity in the phacoemulsification group recovered partially but remained below baseline (40.23 ± 7.80 mm, P = 0.001), whereas sensitivity in the FLACS group returned near baseline (45.25 ± 9.13 mm, P = 0.07). Adjusted analysis favored FLACS at 90 days (mean difference: 5.02 mm; 95% CI: 2.2-7.8; P < 0.001). In the FLACS group, younger age and higher baseline sensitivity were associated with better recovery.
Conclusion
Both techniques caused early postoperative hypoesthesia, but FLACS demonstrated faster and more complete recovery of corneal sensitivity by 90 days. This neurosensory advantage may be particularly relevant for patients predisposed to ocular surface dysfunction.
This protocol compares femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification cataract surgery (CPCS) for age-related cataract using a standardized randomized trial workflow. A total of 113 patients were allocated 1:1 to FLACS (n = 56) or CPCS (n = 57), stratified by nuclear hardness, and assessed at Day 1, Week 1, Month 1, and Month 3. The protocol specifies eligibility screening, concealed allocation, harmonized perioperative care, predefined intraoperative settings, and masked outcome assessment. Primary and secondary outcomes included corrected and uncorrected distance visual acuity, refractive prediction, corneal endothelial cell density, central corneal thickness, intraoperative energy metrics, and adverse events. FLACS reduced cumulative dissipated energy and effective phaco time and showed better Day 1 visual acuity, smaller early central corneal thickening, and milder anterior chamber inflammation (all P < 0.05). At Month 1 and Month 3, between-group differences in visual acuity, refractive prediction error, absolute prediction error, endothelial cell loss, and complications were not significant (all P > 0.05). The protocol supports reproducible evaluation of early recovery advantages while showing comparable short-term safety for both procedures.
Bo Li, Rongjie Wei, Yihui Kang et al.· Journal of Visualized Experi...· 0 citations
Purpose: To evaluate the effect of corneal suture removal timing after phacoemulsification on refractive and corneal astigmatism and best-corrected visual acuity (BCVA). Methods: This prospective, single-center comparative study included 34 patients (34 eyes, aged 40–60 years). All eyes underwent uncomplicated phacoemulsification through a 2.75-mm superior corneal incision closed with a single 10-0 nylon suture. Patients were randomized into two groups: Suture removal at 1 week (Group 1) or at 1 month (Group 2). Refractive astigmatism, keratometric astigmatism, and BCVA were evaluated immediately before suture removal and at 1 h, 1 week, and 1 month afterward. Results: Baseline characteristics were similar between groups (p>0.05), and no wound-related complications occurred. In Group 1, refractive astigmatism decreased significantly from 2.18±0.87 D to 0.88±0.42 D at 1 month after suture removal (p<0.001), with most of the reduction occurring within the first post-operative week. In Group 2, refractive astigmatism showed only a minimal change and did not reach statistical significance (1.61±0.68 D to 1.31±0.53 D; p=0.057). Corneal astigmatism reduction was also more pronounced in Group 1. At 1 month, Group 1 demonstrated significantly lower refractive astigmatism than Group 2. (p=0.037) Vector analysis further supported these findings. The early removal group demonstrated significantly greater surgically induced astigmatism correction (SIA 1.68±0.51 D vs. 1.43±0.54 D; p=0.041) and a lower difference vector (0.49±0.28 D vs. 0.77±0.31 D; p=0.012), indicating more effective reduction of suture-induced astigmatism. Conclusion: Early corneal suture removal after cataract surgery provides a faster and greater reduction in post-operative astigmatism and accelerates visual rehabilitation. When wound stability is adequate, suture removal at approximately 1 week post-operatively may be recommended to optimize early refractive outcomes.
Y. Dağ, Y. B. Akbaş, Said Guler et al.· European Eye Research· 0 citations
PURPOSE
To evaluate changes in scotopic pupil diameter before and after cataract surgery performed by phacoemulsification with intraocular lens implantation.
METHODS
This prospective longitudinal observational study included patients who underwent cataract surgery. Scotopic pupil diameter was measured preoperatively and 30-40 days postoperatively using an automated keratometer after a standardized dark-adaptation period under controlled ambient illumination. Each eye was considered an independent unit of observation. Because some participants contributed both eyes, intraindividual correlation was accounted for using a linear mixed-effects model with random patient intercepts. Time of assessment (preoperative versus postoperative), age, sex, and eye laterality were included as fixed effects.
RESULTS
A total of 354 eyes from 251 patients were analyzed. The mean patient age was 69.3±7.2 yr. Mean scotopic pupil diameter decreased from 5.3±0.9mm preoperatively to 4.8±0.8mm postoperatively, representing a mean reduction of 0.5mm (9.4%). In the linear mixed-effects model, cataract surgery was associated with a significant reduction in pupil diameter, with an adjusted mean difference of 0.45mm (95% confidence interval [95% CI], 0.39-0.51; p<0.001). Age (p=0.061), sex (p=0.920), and eye laterality (p=0.152) were not significantly associated with the magnitude of pupil diameter change.
CONCLUSION
Phacoemulsification with intraocular lens implantation was associated with a significant reduction in scotopic pupil diameter, independent of age, sex, and eye laterality. This finding should be considered during preoperative planning, particularly when selecting intraocular lenses whose optical performance depends on postoperative pupil size.
Hugo Diehl de Souza, José de Mello Rosatelli, Sofia Cabral Saqueti et al.· Arquivos Brasileiros de Ofta...· 0 citations
Background: Cataract is one of the most common preventable causes of blindness in the world, and the gold standard surgical treatment is phacoemulsification (PHACO) with intraocular lens (IOL) implantation. This study aimed to assess the changes in anterior segment biometry, particularly ACD, before and after PHACO with IOL, using A-scan biometry.
Methods: This prospective observational study was conducted at Mugda Medical College Hospital, Dhaka, from July 2024 to December 2025. 100 patients who had uncomplicated PHACO with PCIOL implantation were enrolled. The A-scan ultrasonic biometer was used to measure ACD at baseline (preoperative) and on the 7th postoperative day (POD) and at one month postoperatively. Data were entered and analyzed on SPSS version 26.
Results: The mean age was 61.8 ± 8.7 years, and 56% were male. Age-related cataract was the commonest diagnosis, 62%. Mean ACD increased significantly from 2.92 ± 0.28 mm preoperatively to 3.54 ± 0.31 mm on the 7th POD and 3.58 ± 0.30 mm at one month. The mean increases were 0.62 mm and 0.66 mm, respectively, both statistically significant, P < 0.001.
Conclusions: PHACO, along with IOL, results in a clinically and statistically significant deepening of the ACD, especially in patients with shallow preoperative ACD. These biometric changes are well monitored by A-scan ultrasonic biometry.
S. Bhuiyan, Mahfuza Akter, Taiaba Sultana· Annals of International medi...· 0 citations
To describe and compare the 36-month outcomes associated with femtosecond laser-assisted Descemet stripping endothelial keratoplasty (FS-DSEK) and femtosecond laser-assisted penetrating keratoplasty (FS-PKP) for corneal endothelial decompensation under indication-based surgical selection.
This single-center, retrospective, nonrandomized cohort study included 130 consecutive eyes of 130 patients who underwent FS-DSEK or FS-PKP at Nanjing First Hospital, Nanjing Medical University, between July 2016 and June 2021. All included eyes had 36 months of follow-up, with data collection completed in June 2024. Procedure selection was based on pathological depth and the severity of corneal structural involvement. Visual acuity, central corneal thickness (CCT), ocular discomfort symptoms, refractive parameters, endothelial biomarkers, graft survival, and postoperative complications were evaluated. Longitudinal outcomes were analyzed using generalized estimating equations, and graft survival was estimated using Kaplan-Meier analysis.
Baseline demographic, preoperative ocular, donor-related, and recorded indication variables did not differ significantly between groups. The median time to corneal transparency was shorter in the FS-DSEK group than in the FS-PKP group [4.0 (3.0, 5.25) vs. 5.0 (4.0, 7.0) days,
P
= 0.008]. Both groups showed improvement in ocular discomfort and CCT during follow-up. FS-DSEK was associated with more rapid early-to-intermediate improvement in uncorrected and best-corrected visual acuity, whereas visual outcomes were similar by 36 months. Spherical equivalent remained stable in both groups, while absolute astigmatism was lower after FS-DSEK. Endothelial cell density decreased in both groups; early-to-intermediate endothelial cell loss was greater after FS-DSEK and the difference was no longer statistically significant at 24 or 36 months. The 36-month graft survival rates were 86.7% and 75.8% in the FS-DSEK and FS-PKP groups, respectively, without a significant difference (
P
= 0.198). Graft dislocation occurred only in the FS-DSEK group.
In this indication-based cohort, FS-DSEK was associated with faster corneal clearance, earlier visual recovery, and lower postoperative absolute astigmatism in eyes whose anterior stroma was expected to regain transparency. FS-PKP remained necessary for eyes with irreversible stromal opacity, scarring, degeneration, or full-thickness structural defects. The findings support complementary, anatomy-based procedure selection with procedure-specific postoperative surveillance.
Siqi Xu, Yan-Min Li, Meihuan Wang et al.· BMC Ophthalmology· 0 citations
This study describes the outcomes of femtosecond laser‐assisted cataract surgery (FLACS) in patients with prior corneal scarring and prior anterior lamellar keratoplasty (ALK). Two male patients, aged 65 and 61 years, presented for cataract surgery with a central corneal scar and previous ALK, respectively. Both underwent standard FLACS to address their cataracts amidst these complex corneal conditions. The procedure successfully achieved a centered 5.0 mm capsulotomy without tags or tears, and the lens was segmented into a sextant pattern and removed without difficulty. No serious intraoperative complications occurred. In the first case, best corrected visual acuity improved from 20/150 to 20/40 at 1‐month postoperation, with the patient reporting enhanced visual clarity. In the second case, visual acuity improved from 20/800 to 20/100 1 month after surgery, with further enhancement to 20/60 following scleral lens fitting. This study represents an existing technique on the use of FLACS in patients with ALK and corneal scarring. The findings demonstrate that FLACS can be effectively and safely performed in these challenging cases, providing valuable insights into its potential advantages over traditional manual cataract surgery, particularly in patients with compromised ocular structures and limited lens visibility.
Jordan J. Huang, Yordan A. Urrutia, Jose Miguel Mora Correa et al.· Case Reports in Ophthalmolog...· 0 citations
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