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FLACS versus phaco

FEMCAT study finds outcomes similar regardless of cataract grade

Howard Larkin

Posted: Friday, December 7, 2018


Cédric Schweitzer MD

An analysis of nearly 1,400 eyes of 870 patients participating in the FEMCAT trial comparing femtosecond laser-assisted phacoemulsification cataract surgery (FLACS) with phaco alone found no significant differences in overall clinical outcomes as measured by complication rates, post-op visual acuity, refractive error or change in corneal astigmatism, Cédric Schweitzer MD, PhD, told the 36th Congress of the ESCRS in Vienna.
However, a trend toward better outcomes for lower-grade cataracts was observed in the femto group along with a trend toward better outcomes for the highest grade cataracts in the phaco group, added Dr Schweitzer, of the department of Ophthalmology at Bordeaux University Hospital, France, on behalf of the FEMCAT study group.
In surgery, mean total ultrasound time and dissipated energy were lower in the femto group for both lower- and higher-grade cataracts, while mean aspiration time and BSS volume were significantly higher in the femto group. No specific issues or complications were observed related to the laser procedure, Dr Schweitzer said.
The overall complication rate was 5.8%, with 5.7% in the FLACS group and 6.0% in the phaco group, an insignificant difference. Similarly, the overall rate of logMAR 0.0 best-corrected vision was 84.5%, with 83.6% and 85.4% in the FLACS and phaco groups respectively. Differences between rates of absolute refractive error of 0.75D or more and post-op corneal astigmatism change of 0.5D or greater with axis change of 20 degrees or more were also insignificant.
FEMCAT is a large, randomised prospective study involving four surgeons in each of five centres operating on patients randomised to receive either FLACS or phaco alone with a sham laser procedure. All patients received a 6.0mm hydrophobic acrylic monofocal lens, and were all operated with the same phacoemulsification machine within each centre, though different phaco machines were used at different centres.
Funded by the French Ministry of Health, FEMCAT is intended to assess clinical outcomes in a real-world setting and develop an economic model and cost-effectiveness ratio for FLACS. The results so far do not appear to support a recommendation for payment for FLACS through public health insurance.
“While ultrasound and energy decrease with femto cataract surgery, innovations are still needed to optimise the significant technical advantage of femtosecond laser over phacoemulsification and provide a clinical benefit for patients,” Dr Schweitzer concluded.

Cédric Schweitzer: 
cedric.schweitzer@chu-bordeaux.fr