Clinical and Surgical Outcomes of Femtosecond Laser-Assisted Cataract Surgery (FLACS) on Hard Cataracts in the Egyptian Population

OBJECTIVE: To evaluate the clinical and surgical outcomes of femtosecond laser-assisted cataract surgery (FLACS) in hard cataract of Egyptian population. SETTING: ICare Center, Alexandria, Egypt. DESIGN: Retrospective observational. METHODS: The study included 50 FLACS cases of 40 patients who had cataract; NO4 NC4 or more according to Lens Opacities Classification System III (LOCS III), performed between October 2018 and May 2019. The cases underwent anterior capsulotomy, lens fragmentation, and corneal incisions with the femtosecond laser. Arcuate keratotomy was performed in selected cases. Phacoemulsification and implantation of an intraocular lens are then performed. RESULTS: Patients mean age was 63.06 ± 7.75 yr, mean femtosecond laser energy was 12.92 ± 0.72 mJ, mean docking time was 3.00 ± 0.83 min and overall mean laser treatment time was 92.00 ± 25.01 sec. Mean laser treatment time was lower in cases that did not get astigmatic keratectomy (87.7 ± 18.97 vs 89.47 ± 13.43 sec; p < 0.73). Attempted refraction was −0.09 ± 0.52 D and achieved 12 months postoperative manifest sphere equivalent refraction (SER) was −0.19 ± 1.11 D (r = 0.8 and P˂0.001). Mean error (ME) was −0.2 ± 1.11 (range: −2.5–1.5) while mean absolute error (MAE) was 0.97 ± 0.57 (range: 0–2.5). Eighty percent and 92% of cases had 1 month postoperative SER within 1.0 D and 1.5 D, respectively. One eye (2%) had incomplete capsulotomy, 7 eyes (14%) had incomplete corneal incision and lens fragmentation was complete in all cases except 1 eye (2%). Thirty-four eyes (68%) showed postdocking conjunctival ecchymosis and 35 eyes (70%) had intraoperative miosis. CONCLUSION: FLACS has low complication rate with effective results. High cost of technology is still the main barrier against its popularity.