FLACS Reduces Phaco Time for Medium Density Nuclear Cataracts Only

Eye Surgery
Although the technology reduced effective phacoemulsification in medium denisty cataracts, it only equaled manual methods in very soft or very hard cataracts.

Femtosecond laser-assisted cataract surgery (FLACS) has been associated with positive outcomes in soft and hard nuclear cataract surgeries. But a stuy in Clinical Ophthalmology shows the technology can only reduce total effective phacoemulsification time in medium-density nuclear cataracts.

The researchers conducted a prospective, nonrandomized, comparative study to compare the effective phacoemulsification time in FLACS with traditional quick chop phacoemulsification (QCP) in soft and hard nuclear cataracts. 

The study cohort included 250 eyes from 145 patients (68 men); 117 patients were in the FLACS group and 133 were in the QCP group. Patients were further divided into subgroups based on cataract type: subgroup 1 included those with soft nuclear cataracts (35 FLACS and 42 QCP), subgroup 2 included those with medium nuclear cataracts (40 FLACS and 47 QCP), and subgroup 3 included those with hard nuclear cataracts (42 FLACS and 44 QCP). 

Effective phacoemulsification time in subgroup 1 was typically lower compared with the QCP group, although this difference was not statistically significant (P =.283). Within subgroup 3, lower effective phacoemulsification values were noted in the FLACS group, but differences compared with the QCP group were not statistically significant (P =.122). However, in subgroup 2, effective phacoemulsification time was significantly lower for patients who underwent FLACS compared with QCP (P <.0001). 

Study limitations include the use of the 21 G phacoemulsification tip, which has a narrowed 0.5 mm inner diameter; the use of a 19 G tip with a wider inner diameter may have resulted in further reduction of energy use. 

“FLACS significantly reduces effective phacoemulsification time during emulsification of medium density nuclear cataracts in comparison to QCP,” the research demonstrates. “Regarding very hard and soft nuclear cataracts, FLACS is not superior over QCP in reducing the effective phacoemulsification time.” 

FLACS does offer other advantages over a conventional phacoemulsification, however, such as accurate sizing and centration of capsulotomies, especially in hard and soft nuclear cataracts.


Assaf AH, Aly MG, Zaki RG, Shaaban YM, Aziz BF. Femtosecond laser-assisted cataract surgery in soft and hard nuclear cataracts: A comparison of effective phacoemulsification time. Clin Ophthalmol. 2021;15:1095-1199. doi:10.2147/OPTH.S300145