OBJECTIVES: There has been increased interest in femtosecond laser-assisted cataract surgery (FLACS) due to potential for improved efficacy, efficiency, and safety. The objective was to conduct a pairwise meta-analysis comparing LenSx FLACS to phacoemulsification cataract surgery (PCS) in patients undergoing cataract surgery.

METHODS: A systematic literature review identified 29 clinical studies comparing LenSx to PCS from 2010 to August 2016. Commonly reported outcomes were identified which included best corrected visual acuity (BCVA; logMAR), endothelial cell density (ECD; cells/mm), central corneal thickness (CCT; µm), phacoemulsification time (seconds), effective phacoemulsification time (EPT; seconds) and phacoemulsification energy (%). BCVA, ECD and CCT were reported as the mean difference between procedures in the change from baseline while the remaining outcomes were reported as the mean difference between procedures. The meta-analysis was performed using STATA and included random and fixed effects models for each outcome. Where possible, the LenSx pre-SoftFit and LenSx SoftFit systems were considered separately as SoftFit is a newer system.

RESULTS: Seven studies reported comparable outcomes. LenSx was associated with lower phacoemulsification energy versus PCS (-3.72; 95% CI [-5.01, -2.43]. EPT was statistically significantly lower for LenSx SoftFit compared to PCS (-2.59; 95% CI [-3.11, -2.08]). At one week post-surgery, change in CCT was lower with LenSx versus PCS (-1.62; 95% CI [-3.12, -0.11]). Phacoemulsification time was lower with LenSx versus PCS, but was not found to be statistically significantly different, though could be considered clinically relevant as the CI has minimal overlap with 0. High heterogeneity among studies, as evidenced by I-squared statistics, and variation in study design made it difficult to draw conclusions across remaining outcomes.

CONCLUSIONS: The results suggest that LenSx performs better than PCS for outcomes including phacoemulsification energy, EPT and CCT at one week. This analysis highlights the need for consistent reporting across future FLACS studies.