The application of the femtosecond laser in cataract surgery

Introduction: Since the introduction, femtosecond laser-assisted cataract surgery (FLACS) was believed to revolutionize cataract surgery. However, the judgment of clinical benefits was found to be far more complex than initially might have been thought. The aim of this review was to analyze the benefits and drawbacks of FLACS compared to traditional phacoemulsification cataract surgery. Results: The benefits of FLACS include lower cumulated phacoemulsification time and endothelial cell loss, perfect centration of the capsulotomy, and the possibility to perform precise femtosecond-assisted arcuate keratotomy incisions. The major disadvantages of FLACS are: high cost of the laser and the disposables for surgery, FLACS-specific intraoperative capsular complications, as well as the risk of intraoperative miosis and the learning curve. Conclusions: FLACS seems to be beneficial in some groups of patients i.e., with low baseline endothelial cell count, or those planning to receive multifocal intraocular lenses. Nevertheless, having considered that the advantages of FLACS might not be clear in every routine case, it cannot be considered as cost-effective.