Journal of cataract and refractive surgery最新文献

{"title":"Optimizing flange geometry with a 532-nm green laser for four-flanged scleral fixation: an experimental comparison with thermal cautery.","authors":"Do Hee Park, Kyung Yoon Kook, Yong-Sok Ji, Sang Woo Park","doi":"10.1097/j.jcrs.0000000000002065","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000002065","url":null,"abstract":"<p><strong>Synopsis: </strong>A 532-nm green laser was a feasible alternative to cautery, producing larger, flatter flanges at shorter heating lengths and supporting 1.0-mm laser heating for four-flanged scleral fixation.</p><p><strong>Purpose: </strong>To compare flange geometry produced with a 532-nm green laser versus thermal cautery in four-flanged scleral fixation and to identify practical heating lengths for 5-0 and 6-0 polypropylene sutures.</p><p><strong>Setting: </strong>Dry laboratory.</p><p><strong>Design: </strong>Bench-top experimental study.</p><p><strong>Methods: </strong>Flanges were created on 5-0 and 6-0 polypropylene sutures using a 532-nm green laser (200 mW, 200 ms, single-shot mode) or handheld thermal cautery. Heating length, defined as the distance from the suture tip to the forceps, ranged from 0.5 to 3.0 mm in 0.5-mm increments. Flange diameter and height were measured microscopically, and shape was summarized by the diameter-to-height (D/H) ratio.</p><p><strong>Results: </strong>Flange diameter and height increased with heating length for both devices. The laser produced larger diameters than cautery for 6-0 polypropylene at 0.5-1.5 mm (all P < .001) and for 5-0 polypropylene at 0.5-2.5 mm (P ≤ .023). At shorter heating lengths, the laser tended to produce flatter, saucer-shaped flanges with higher D/H ratios, whereas cautery often produced taller, mushroom-shaped profiles. Using guide-needle outer diameters as practical surrogate targets (30-gauge ≈ 300 μm for 6-0; 27-gauge ≈ 400 μm for 5-0), the shortest heating length at which mean flange diameter exceeded the target was 1.0 mm with laser and 1.5 mm with cautery for both suture sizes.</p><p><strong>Conclusions: </strong>Laser-assisted flange formation appears to be a feasible alternative to thermal cautery. In this dry-laboratory model, 1.0-mm laser heating and 1.5-mm cautery heating provided practical target flange dimensions while maintaining modest flange height.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repeatability of an SD-OCT biometer (MS-39 AL) and agreement with a validated biometer (IOLMaster 700).","authors":"Gianluca Cappuccini, Kenneth J Hoffer, Arianna Grendele, Catarina C P Coutinho, Domenico Schiano-Lomoriello, Giacomo Savini","doi":"10.1097/j.jcrs.0000000000002064","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000002064","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the repeatability of biometric measurements obtained with the MS-39 AL (CSO) and to assess their agreement with those provided by the IOLMaster 700 (Carl Zeiss).</p><p><strong>Setting: </strong>IRCCS Bietti Foundation, Rome, Italy.</p><p><strong>Design: </strong>Prospective evaluation of diagnostic test.</p><p><strong>Methods: </strong>Patients were classified in Group A (with cataract) and Group B (with clear lens). For repeatability analysis, three measurements were obtained with the MS-39 AL. Agreement was analyzed by comparing the first MS-39 AL measurement with the corresponding measurement by the IOLMaster 700.</p><p><strong>Results: </strong>111 eyes were enrolled. Group A included 53 eyes (mean age: 69.4 ±7.3 years) and Group B 58 eyes (mean age 35.5 ±9.1 years). In both groups, the MS-39 AL demonstrated high repeatability for all biometric parameters, as the coefficient of variation ranged from 0.04% for axial length to 2.10% for lens thickness, except in the case of corneal astigmatism. Agreement between biometers was high for most parameters, with narrow 95% limits of agreement. Significant differences were observed for anterior chamber depth (MS-39 AL = 3.52±0.44 mm, IOLMaster 700 = 3.42±0.45 mm, p <0.0001), corneal diameter (MS-39 AL = 11.90±0.46 mm, IOLMaster 700 = 12.19±0.49 mm, p <0.0001), central corneal thickness (MS-39 AL = 531.75±31.20 µm, IOLMaster 700 = 534.80±32.79 µm, p <0.001) and lens thickness (MS-39 AL = 4.18±0.55 mm, IOLMaster 700 = 4.13±0.52 mm, p = 0.002).</p><p><strong>Conclusions: </strong>The MS-39 AL provides highly repeatable biometric measurements and shows good agreement with the IOLMaster 700 for most parameters in both cataractous and clear-lens eyes.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jacques Daviel's Summer 1750 Trip to the Meuse-Rhine Region and Newly Discovered Announcement of a Revolution in Eye Surgery.","authors":"Christopher Theodore Leffler, Stephen G Schwartz, Andrzej Grzybowski","doi":"10.1097/j.jcrs.0000000000002063","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000002063","url":null,"abstract":"<p><p>Jacques Daviel (1696-1762) is credited with introducing planned primary cataract extraction. We analyzed historical books, newspapers, manuscripts, and documents discovered between 2004 and 2026, including previously unreported notices in the 1750 Gazette de Cologne. On July 7, 1750, Daviel performed an experimental crystalline lens extraction in a sheep before professors in Louvain. Although he later claimed to have performed cataract extractions in Liège, no contemporaneous documentation of those procedures survives. On September 10, 1750, he performed a witnessed sheep experiment before the Cologne medical faculty, and on September 18 performed a planned primary cataract extraction on the cleric Gilles Nouprez, whose immediate visual improvement was reported in the Gazette de Cologne. The newspaper announced Daviel's new technique on September 22, 1750, representing, to our knowledge, the earliest published documentation of planned primary cataract extraction.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-year clinical outcomes of theranostic-guided transepithelial corneal UV therapy for progressive keratoconus.","authors":"Marco Lombardo, Sebastiano Serrao, Rita Mencucci, Matilde Buzzi, Danilo Alunni Fegatelli, Annarita Vestri, Giuseppe Lombardo","doi":"10.1097/j.jcrs.0000000000002040","DOIUrl":"10.1097/j.jcrs.0000000000002040","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of theranostic-guided transepithelial corneal UV therapy in treatment of progressive keratoconus and the association between theranostic imaging biomarkers and 1-year outcomes.</p><p><strong>Setting: </strong>Careggi hospital and Studio Italiano di Oftalmologia, Rome, Italy.</p><p><strong>Design: </strong>Real-world evidence case series.</p><p><strong>Methods: </strong>55 consecutive patients (55 eyes) were treated using a theranostic UV medical device. A 0.22% riboflavin ophthalmic solution was applied onto the cornea with intact epithelium for 20 minutes followed by UV irradiation at 10 mW/cm 2 for 9 minutes in all cases. The theranostic UV device generated intraoperative imaging biomarkers, the riboflavin score and theranostic score , quantifying corneal riboflavin concentration and photoactivation efficacy, respectively. The device-guided surgeons in completing treatment based on real-time biomarker monitoring.</p><p><strong>Results: </strong>54 patients (54 eyes) completed 1-year follow-up. Treatment was safe and effective, with the predefined riboflavin score (>0.4 d.u.) and theranostic score (≥0.6 dimensionless units) thresholds accurately identifying maximum keratometry index (K max ) flattening at 1 year in 93% of cases. Additional riboflavin was required in 21% of eyes (n = 12), and 15% additional UV energy was required in 5% of eyes (n = 3) to reach the theranostic thresholds, thus precisely adjusting the required dose of riboflavin and UV light for each eye. Mean K max decreased by -1.5 ± 1.5 diopters ( P < .001) with clinically significant improvements in both uncorrected and corrected distance visual acuities ( P < .001).</p><p><strong>Conclusions: </strong>Theranostic-guided corneal UV therapy enables patient-specific modulation of riboflavin dosing and UV-A delivery, optimizing corneal flattening and visual outcomes while minimizing the risk of treatment failure under epithelium-on conditions in progressive keratoconus.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aberration-guided intraocular lens power calculation in keratoconus: ray-tracing optimization.","authors":"Magali M S Vandevenne, Jaime Aramberri, Tos T J M Berendschot, Rudy M M A Nuijts, Pablo Pérez-Merino","doi":"10.1097/j.jcrs.0000000000002029","DOIUrl":"10.1097/j.jcrs.0000000000002029","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the accuracy of ray-tracing optimization (RTO) for predicting postoperative refractive error in keratoconic cataract eyes.</p><p><strong>Setting: </strong>University Eye Clinic, Maastricht, the Netherlands.</p><p><strong>Design: </strong>Case series. Evaluation of technology.</p><p><strong>Methods: </strong>22 keratoconic eyes that underwent cataract surgery were included in the study. Anterior and posterior corneal Zernike coefficients, axial distances, and intraocular lens (IOL) geometry were exported to custom-developed RTO algorithms to build patient-specific eye models. Optical quality was quantified with the Visual Strehl of the Optical Transfer Function (VSOTF) ratio. The defocus and astigmatism maximizing VSOTF were taken as the optimal target refraction and compared with postoperative subjective refraction using power vectors (spherical equivalent [SEQ], J 0 , and J 45 ). Agreement was assessed with Bland-Altman analysis, and prediction accuracy was summarized as the percentage within ±0.5 diopters (D) and ±1.0 D.</p><p><strong>Results: </strong>Bland-Altman analysis showed good agreement between RTO-predicted and postoperative subjective refractions, particularly for SEQ and J 0 (with-the-rule/against-the-rule astigmatism). The percentage of eyes within ±0.5 D of prediction error was 68.2% for SEQ and J 0 and 59.1% for J 45 ; within ±1.0 D, it was 86.3% (SEQ), 81.8% (J 0 ), and 77.3% (J 45 ). Cataract surgery in keratoconic eyes did not induce significant variations in the corneal Zernike coefficients. RTO accuracy was highest when vertical coma (Z 3-1 ) predominated as the main higher-order aberrations (HOAs).</p><p><strong>Conclusions: </strong>Aberration-guided RTO provides accurate postoperative refractive predictions in keratoconic cataract eyes. Accuracy is particularly strong in eyes dominated by vertical coma, supporting inclusion of measured HOAs in IOL power selection.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biometry-Driven Selection of IOL Power Calculation Formulas Using the ESCRS IOL Calculator.","authors":"Youngsub Eom, Miri Na, Jinhwan Park, Youngbin Song, Dong Hyun Kim, Cheolmin Yun, Jong Suk Song, David L Cooke, Kyungmin Koh","doi":"10.1097/j.jcrs.0000000000002055","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000002055","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the accuracy of a biometric subgroup-based intraocular lens (IOL) power calculation formula selection strategy using the ESCRS IOL Calculator.</p><p><strong>Setting: </strong>Kim's Eye Hospital and Korea University Ansan Hospital, Republic of Korea.</p><p><strong>Design: </strong>Retrospective comparative study.</p><p><strong>Methods: </strong>A total of 626 eyes that underwent uncomplicated cataract surgery with in-the-bag IOL implantation were included. Eyes were divided into a derivation dataset (351 eyes) and an independent external-validation dataset (275 eyes). Biometric subgroups were defined based on combinations of keratometry (K), anterior chamber depth (ACD), and axial length (AL), resulting in 640 subgroups. For each subgroup, the formula with the lowest mean absolute error (MAE) was selected using the derivation dataset. For subgroups not represented in the derivation dataset, formulas were assigned using a median-based approach. Prediction accuracy in the validation dataset was compared between the subgroup-based method and seven individual formulas.</p><p><strong>Results: </strong>The subgroup-based method demonstrated the lowest MAE (0.24 ± 0.19 D) and MedAE (0.19 D) among all methods (p<0.001). The proportion of eyes within ±0.50 D was higher with the subgroup-based method (89.1%) compared with individual formulas (approximately 80%; p<0.001). The subgroup-based method also showed the highest IOL Formula Performance Index (0.609) compared with individual formulas (0.377-0.560).</p><p><strong>Conclusions: </strong>Selecting IOL power calculation formulas according to biometric subgroups defined by K, ACD, and AL improves refractive prediction accuracy compared with individual formulas. A biometry-driven formula selection strategy using the ESCRS IOL Calculator may provide a clinically useful approach for optimizing refractive outcomes after cataract surgery.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-related fragility of the anterior lens capsule: histopathologic study of 244 cataract surgery cases.","authors":"Masanobu Iida, Yoichiro Masuda, Mari Yamazaki, Kosuke Ichihara, Koji Komatsu, Ai Iwauchi, Hoshiho Kubota, Masayuki Shimoda, Tadashi Nakano","doi":"10.1097/j.jcrs.0000000000002060","DOIUrl":"10.1097/j.jcrs.0000000000002060","url":null,"abstract":"<p><strong>Purpose: </strong>To identify the clinical and biometric factors associated with the histopathological splitting of the anterior lens capsule in eyes undergoing cataract surgery.</p><p><strong>Setting: </strong>The Jikei University Hospital, Minato-ku, Tokyo, Japan.</p><p><strong>Design: </strong>Single-center retrospective cross-sectional study.</p><p><strong>Methods: </strong>The study included patients who underwent cataract surgery between 2022 and 2025 and had an anterior capsulorhexis specimen and complete clinical data (1 eye per patient). Specimens were stained with hematoxylin-eosin and Masson trichrome and assessed for capsular splitting. Collected variables were age, sex, nuclear hardness (Emery-Little classification), diabetes mellitus, axial length, and lens thickness. Factors associated with splitting were examined using logistic regression.</p><p><strong>Results: </strong>244 patients (244 eyes) were included. Capsular splitting was observed in 69 of 244 eyes (28.3%). In univariable analysis, older age (per 1-year increase: odds ratio [OR], 1.121; 95% CI, 1.081-1.162; P < .001), nuclear hardness grade ≥3 (OR, 2.821; 95% CI, 1.379-5.771; P = .005), shorter axial length (per mm: OR, 0.763; 95% CI, 0.648-0.900; P = .001), and greater lens thickness (per mm: OR, 4.224; 95% CI, 2.232-7.993; P < .001) were significantly associated with splitting. Sex and diabetes mellitus were not associated with splitting. In multivariate analysis, which included variables significant in the univariable analysis, only age remained independently associated with splitting (per 1-year increase: OR, 1.105; 95% CI, 1.062-1.151; P < .001).</p><p><strong>Conclusions: </strong>Capsular splitting is primarily age-related. These results suggest progressive weakening of the anterior lens capsule with increasing age.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply : Light adjustable lens implantation with cataract surgery in eyes with macular pathology.","authors":"Tanner J Ferguson","doi":"10.1097/j.jcrs.0000000000002050","DOIUrl":"10.1097/j.jcrs.0000000000002050","url":null,"abstract":"","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Macular Edema and Intraocular Pressure Outcomes Following Periocular versus Topical Corticosteroids After Phacoemulsification: A Systematic Review and Meta-Analysis.","authors":"Pedro Henrique Ferrazza Sperotto, Nuno Rodrigues Alves, Carolina Carvalho Soares Valentim, Neeran Narainswami, Guilherme Melchior Maia Lopes, Eduardo de Carvalho Mazzocato, Marco Antonio Ferrazza Sperotto, Melis Kabaalioglu Guner","doi":"10.1097/j.jcrs.0000000000002061","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000002061","url":null,"abstract":"<p><strong>Topic: </strong>Postoperative inflammation after phacoemulsification is routinely managed with topical corticosteroids, while periocular administration may provide a sustained anti-inflammatory effect.</p><p><strong>Clinical relevance: </strong>Pseudophakic cystoid macular edema (PCME) remains a leading cause of suboptimal visual recovery after cataract surgery. Periocular corticosteroid injections may offer a single-dose alternative to topical regimens, minimizing adherence-related limitations.</p><p><strong>Methods: </strong>Following PRISMA 2020 guidelines (PROSPERO CRD420250632011), PubMed, Embase, and the Cochrane Central Registered of Controlled Trials (CENTRAL) were searched from inception to December 1, 2025, for studies comparing intraoperative periocular injections versus postoperative topical corticosteroids in adults undergoing uncomplicated phacoemulsification. Primary outcomes were PCME incidence and postoperative intraocular pressure (IOP). Best-corrected visual acuity (BCVA) was a secondary outcome. Data were pooled using a random-effects model.</p><p><strong>Results: </strong>Ten studies involving 57,564 eyes were analyzed. PCME incidence was comparable between groups (5 studies, 56,766 eyes; 1.10% periocular vs 1.40% topical; Risk Ratio (RR), 0.84; 95% CI, 0.55-1.28; P = .42; I2 = 65%). Eight studies (1,829 eyes) showed no clear difference in postoperative IOP (Mean Difference (MD), 0.28 mmHg; 95% CI, -0.20 to 0.77; P = .25; I2 = 65%). BCVA outcome was similar between groups (4 studies, 1,188 eyes; MD, -0.01 logMAR; 95% CI, -0.03-0.01; P = .31; I2 = 0%). Follow-up varied by outcome, extending from approximately 1 month to 120 days.</p><p><strong>Conclusion: </strong>Current evidence found no clear differences in PCME risk, postoperative IOP, or BCVA between periocular and topical corticosteroids following uncomplicated phacoemulsification. Findings should be interpreted cautiously given the heterogeneity and low certainty evidence. Clinical use should consider drug, formulation, dose, injection route, and the need for longer-term monitoring.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femtosecond laser-assisted cataract surgery versus phacoemulsification in shallow anterior chambers: a systematic review and meta-analysis.","authors":"Shih-Heng Hung, Chiao-Hsin Lan, Ya-Hsin Yao, Ta-Hung Chiu, Da-Wen Lu, Yann-Guang Chen, Wei-Ting Yen","doi":"10.1097/j.jcrs.0000000000002062","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000002062","url":null,"abstract":"<p><strong>Topic: </strong>To evaluate the efficacy and safety of femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification in eyes with shallow anterior chambers or primary angle-closure disease, with endothelial cell loss (ECL) as the primary outcome. (PROSPERO: [MASKED FOR PEER REVIEW]).</p><p><strong>Clinical relevance: </strong>Shallow anterior chambers pose unique surgical challenges during phacoemulsification, placing the corneal endothelium at increased risk of damage. This population, disproportionately prevalent in Asia, is expected to grow substantially with aging demographics, underscoring the need for optimized surgical strategies.</p><p><strong>Methods: </strong>MEDLINE, Embase, and Cochrane CENTRAL were searched through January 2026. Randomized controlled trials and observational studies comparing FLACS with conventional phacoemulsification were included. Risk of bias was assessed using Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale. Pooled estimates were calculated using random-effects models; certainty of evidence was evaluated using the GRADE framework.</p><p><strong>Results: </strong>Six studies (505 eyes) were analyzed. FLACS was associated with lower ECL (mean difference [MD] -4.97%; 95% confidence interval [CI]: -8.27 to -1.67; P = .003; I2 = 98%) and cumulative dissipated energy (MD -2.47; 95% CI: -3.64 to -1.30; P < .001; I2 = 14% in sensitivity analysis). FLACS was associated with 60% lower odds of early postoperative complications (odds ratio 0.40; 95% CI: 0.23 to 0.68; P < .001; I2 = 0%). Visual outcomes were comparable.</p><p><strong>Conclusion: </strong>FLACS was associated with fewer early postoperative complications, supported by moderate-certainty evidence, and with lower endothelial cell loss and ultrasound energy, although the magnitude of these benefits remains uncertain on low-certainty evidence.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}