Femtosecond Laser Pretreatment Does Not Induce Prostaglandin Release

Laser surgery for vision correction and cataract removal
Laser-assisted cataract surgery without NSAIDS with either fragmentation or capsulotomy performed first, do not affect PGE-2 levels in the aqueous or pupil diameter.

In patients undergoing low-energy femtosecond laser-assisted cataract surgery (LCS) without anti-inflammatory premedication with either fragmentation or capsulotomy performed first, prostaglandin E2 (PGE-2) levels in the aqueous and pupil diameter remain steady, according to a study published in the American Journal of Ophthalmology.

A prospective, randomized, fellow-eye controlled comparison study looked at 140 eyes of 70 consecutive patients who had immediate sequential bilateral cataract surgery at the Department of Ophthalmology, Medical University of Vienna with either anterior capsulotomy before lens fragmentation (caps-first) in the first eye or lens fragmentation before capsulotomy (frag-first) done in a randomized order. Five minutes after LCS, aqueous was tapped and PGE-2 concentration was analyzed. Researchers recorded pupil diameters immediately before and after femtosecond laser pretreatment. The main outcome measurements were PGE-2 concentrations in picograms/milliliter and pupil diameter in millimeters.

They found that mean PGE-2 concentrations were 42.0±63.7pg/mL in the caps-first group vs 71.8±160.7pg/mL in the frag-first group (P =.186). Before and after pretreatment, mean pupil diameters were 7.6±0.8 mm and 7.6±0.8 mm, respectively (P =.871). No significant differences were found between time points or groups for mean PGE-2 concentrations and pupil diameters. Also, no pupillary miosis was found.

“The low-energy pulses delivered at high frequencies by the [femtosecond laser] platform used in this study did not induce clinically significant prostaglandin release into the aqueous and no significant pupillary constriction. No NSAID pretreatment is required prior to low-energy femtosecond laser assisted cataract surgery,” they report.

One limitation of the study that they highlighted was how the delay in pupil size measurements “differ between previous studies using regular [femtosecond laser] devices and the current study.”


Schwarzenbacher L, Schartmüller D, Leydolt C, Menapace R. Prostaglandin release after low-energy femtosecond laser-assisted cataract surgery without anti-inflammatory drug premedication. Am J Ophthalmol. January 13, 2022. doi:10.1016/j.ajo.2022.01.002