Femto vs cataract?

Major study shows no statistical difference between the two procedures

Dermot McGrath

Posted: Monday, July 9, 2018

A large-scale prospective, multi-centre French study comparing femtosecond laser cataract surgery and phacoemulsification showed similar outcomes and complication rates between the two procedures, according to Cedric Schweitzer MD.
“We found no statistical difference between the femto and phaco treatment groups for all of the visual and refractive criteria that were evaluated. Furthermore, of the small differences that we did find between the groups, there was no evidence that there was any clinical benefit to the patient,” he told delegates attending the annual meeting of the French Implant and Refractive Surgery Association (SAFIR).
Funded by €3.2m from the French health ministry, the two-year FEMCAT study was designed to establish a scientific basis for the theoretical benefits of femto-cataract surgery compared to standard phacoemulsification. The study employed a robust methodology to limit selection bias in each of the five French clinical centres involved, said Dr Schweitzer. Four experienced cataract surgeons were selected for each participating centre, with a total of 757 eyes randomly allocated to the femtosecond laser arm and 752 to the phacoemulsification arm.
“Everything was geared to make this a meaningful real-life study using surgeons of different age, training and experience, while standardising the various surgical procedures between the two groups in order to analyse the impact of the femtosecond laser alone,” said Dr Schweitzer. He noted that each centre used the same phaco machine for all procedures, although machines could differ from one centre to another, and all patients were implanted with a standard 6.0mm hydrophobic acrylic implant.
Significant improvements in visual acuity and refraction were observed in both patient groups with no significant differences between them, said Dr Schweitzer. Astigmatism outcomes were similar for both groups and no complication specifically related to the laser procedure occurred intraoperatively, he added.
While no significant difference has been found between the two groups thus far, Dr Schweitzer said that the next step was to carry out further analysis of specific patient sub-groups in terms of cataract grade and surgeon experience.
“Although we found no clinical advantage in using femtosecond laser cataract surgery, the technology may still potentially represent a new paradigm if certain conditions are met. Association with other innovations in fluidics and new implant designs might also help to take advantage of the highly precise cutting ability of the femtosecond laser in the future,” Dr Schweitzer said.

Cedric Schweitzer: