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Comparison of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification (PE) on dense cataracts: a randomised controlled trial

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Session Details

Session Title: Evolution in FLACS & Phaco Technology

Session Date/Time: Sunday 23/09/2018 | 08:00-09:45

Paper Time: 08:12

Venue: Room A3, Podium 2

First Author: : S.Chee SINGAPORE

Co Author(s): :    M. Wong                    

Abstract Details


To compare the corneal safety of FLACS vs PE and the grid (FLACSg) vs 16 segment (FLACS16) fragmentation pattern in managing dense cataracts.


Singapore National Eye Centre, a tertiary referral public eye care centre


Prospective randomized study recruited patients with nuclear opacity (NO) grade 5, 6 or more on LOCS III. Exclusion criteria: corneal endothelial cell count (ECC) < 1500 cells/mm2, eyes unsuitable for FLACS, cataracts with additional complexities. Eyes randomized to PE, FLACSg (600µm) or FLACS16 in ratio 2:1:1 by single surgeon. Victus™ (Bausch + Lomb, Munich, Germany) laser platform and Stellaris PC (Bausch + Lomb, Rochester, New York) were used. Data collected: preoperative and 1 month post-operative best corrected visual acuity (BCVA), ECC, effective phacoemulsification time (EPT) and perioperative complications. Outcome measures: Loss of ECC at 1 month and EPT.


80 patients randomized: 40 PE, 20 FLACSg, 20 FLACS16. Majority Chinese (74, 92.5%) and mean age of 75 ±8 years old. Cataracts mostly NO5-6 (49, 61.3%). Mean EPT 7.96±3.73s, being significantly higher in PE (9.09s) than FLACS (7.01s). No difference amid FLACSg and FLACS16 (P>0.05, Independent t test). Mean ECC loss 250±210 cells/mm2, being significantly higher in PE (311) than FLACSg (135) and FLACS16 (241) (P= 0.007, F=5.26, One way ANOVA), and no difference between FLACS groups. Mean 1 month postoperative LogMAR BCVA (0.21±0.20) significantly better than preoperative BCVA (1.04±0.87)(t=8.709, p<0.001, Paired t test).


FLACS significantly reduced the mean EPT and lowered the mean ECC loss during phacoemulsification in dense cataracts. There was no difference in these parameters between nuclear fragmentation using grid pattern or 16 segment pattern.

Financial Disclosure:

... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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