Femtosecond Laser-Assisted Cataract Surgery: Precision, Safety, and Visual Outcomes — A Comparative Study with Conventional Phacoemulsification at Habboubi Teaching Hospital

Abstract

Overview: FLACS is thought to have advantages in improving the accuracy of specific procedures such as capsulotomy, nuclear fragmentation and corneal incisions when compared with traditional phacoemulsification. It remains controversial whether the technical improvements lead to better safety and visual outcomes in teaching hospitals. Objectives: The main objectives of the study are to determine the accuracy of capsulotomy, EPT, CDE, corneal endothelial cell damage, visual results, and complication rates in FLACS and CPS in patients who underwent cataract surgery at Habboubi Teaching Hospital. Methods: A prospective, comparative, and intervention study was carried out in the Department of ‎Ophthalmology, Habboubi Teaching Hospital, from January to December 2025. One hundred twenty eyes of 120 cases of age-related cataract were divided equally into two groups; Group A received FLACS with the femtosecond laser system for capsulotomy, lens fragmentation, and corneal incisions before phacoemulsification, whereas Group B received CPS. The accuracy of capsulotomy, EPT, CDE, loss of corneal endothelial cells, CDVA, and any complications were measured at day 1, week 1, and month 1. Results: Capsulotomy deviation from the target diameter was significantly smaller in Group A (0.08 ± 0.04 mm) than Group B (0.31 ± 0.15 mm; p < 0.001). Mean EPT (4.2 ± 1.8 vs 9.6 ± 3.4 seconds) and CDE (3.1 ± 1.4% vs 7.8 ± 2.9%) were significantly lower in Group A (p < 0.001 for both). Endothelial cell loss at 1 month was lower in Group A (6.8 ± 3.2%) than Group B (9.4 ± 3.9%; p = 0.01). At week 1, 85.0% of Group A versus 71.7% of Group B achieved CDVA ≥ 6/9 (p = 0.03); this difference was not significant by month 1 (93.3% vs 90.0%; p = 0.51). Capsule tear in the anterior region occurred more frequently in Group A (3.3% compared to 1.7%), whereas capsular tear in the posterior region was observed more often in Group B (3.3% compared to 1.7%); however, no significant difference was observed. Conclusion: FLACS showed better capsulotomy accuracy, less phacoemulsification energy, and faster visual improvement at the early stage of treatment compared to CPS, with no difference in safety, although there was some trend towards greater anterior capsule problems during learning curve period.