Femtosecond laser-assisted cataract surgery (FLACS) offers no significant safety advantage over conventional phacoemulsification cataract surgery (CPCS), according to new research presented at the American Society of Cataract and Refractive Surgery Annual Meeting 2026.
The findings, presented during the April 10–13 meeting in Washington, DC, suggest both techniques demonstrate equivalent safety across a range of intraoperative and postoperative outcomes.
Lead author Dr Ping-Chiao Tsai, of Tzu Chi University School of Medicine in Taiwan, and colleagues including Yu-Chieh Chiu, conducted a meta-analysis of 17 randomised controlled trials encompassing 4,466 eyes. The studies were sourced from databases including PubMed and Embase up to July 2025.
The team examined key intraoperative complications such as anterior and posterior capsular rupture, alongside postoperative outcomes including macular oedema, corneal oedema, elevated intraocular pressure (IOP), and posterior capsular opacification (PCO).
Overall, complication rates did not differ significantly between the two approaches.
“[The] overall complication rates did not differ significantly between FLACS and CPCS (P = 0.862), including subgroup analysis by laser platform,” the researchers reported.
Rates of anterior capsular rupture were 1.16% in the FLACS group compared with 0.93% for CPCS. Posterior capsular tears were slightly lower with FLACS (0.85% versus 1.52%), although this difference was not statistically significant.
Postoperative outcomes showed similar parity. The analysis found no meaningful differences in macular oedema at three or 12 months, corneal oedema in the early postoperative period, 24-hour IOP spikes, or the development of PCO within one year.
The findings aim to address ongoing debate about whether laser-assisted cataract surgery confers additional safety benefits over conventional techniques. According to the authors, both methods are “remarkably safe,” allowing surgeons to base their choice on other factors.
These include surgeon preference, individual patient characteristics, and cost-effectiveness considerations, rather than any perceived safety advantage associated with femtosecond laser use.
Source: Data presented at the American Society of Cataract and Refractive Surgery Annual Meeting 2026; Tsai PC, Chiu YC, Wang JH, Chiu CJ. Safety outcomes of femtosecond laser-assisted cataract surgery vs. conventional phacoemulsification cataract surgery: meta-analysis of RCTs. Poster 118687.
