Written By: 
Refractive Mgmt/Intervention


This large retrospective analysis compared the postoperative outcomes of eyes treated with femtosecond laser-assisted cataract surgery (FLACS) with those that received manual cataract surgery (MCS).

Study design

Investigators included 1,838 consecutive eyes of 1,089 patients who underwent surgery over a 3-year period at a single center. Of these, 955 had FLACS and 883 eyes had MCS.


At postoperative week 3, 82.6% of FLACS eyes and 78.8% of MCS eyes had absolute refractive error of less than 0.5 D, which was not statistically significant. There was also no difference in the percentage of eyes with errors less than 0.25 D or 1.0 D. Visual acuity outcomes did not differ between groups.

Regardless of procedure, favorable refractive outcomes were most common in eyes with an axial length between 22 and 24.8 mm, a toric intraocular lens, less preoperative cylinder, and greater preoperative average keratometry.  


Not every patient has completely stable refraction at postoperative week 3, although this study involved a large number of eyes. Other limitations include the study’s retrospective, non-randomized design.

Clinical significance

This study joins a number of other large studies that have not demonstrated refractive superiority of femtosecond laser-assisted cataract surgery. Furthermore, eyes that underwent FLACS had a higher incidence of complications such as posterior or anterior capsule tears, corneal edema and posterior capsule opacification requiring YAG.