Plain language summary Laser‐assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery Key messages ‐ There are probably no clinically important differences between the two methods of cataract surgery in terms of complications, visual acuity (ability to distinguish shapes and objects at a given distance) and quality of life. ‐ Femtosecond laser‐assisted cataract surgery (FLACS) was more expensive and there was some evidence that phacoemulsification cataract surgery (PCS) may be more cost‐effective. ‐ There were differences in how studies reported outcomes: standardised outcome reporting would help future comparisons. What is a cataract? Cataract is clouding of the lens inside the eye. It is the leading cause of blindness in the world. What is cataract surgery? Cataract surgery is one of the most performed operations globally. During standard surgery, the surgeon opens the front of the lens capsule (the lens outer layer or ‘skin’), removes the cloudy lens material inside the capsule and places a clear artificial lens in the remaining capsular bag. The aim of femtosecond laser‐assisted cataract surgery (FLACS) is to provide more precise control over the steps involved in cataract surgery. By being more precise, it is plausible that this could lead to better outcomes or higher safety for people undergoing cataract surgery. What did we want to find out? The aim of this Cochrane Review was to find out what the benefits and harms of FLACS are compared with standard ultrasound PCS. What did we do? We searched for studies that compared PCS to FLACS in people with age‐related cataracts. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and study size. What did we find? The analysis included 42 studies that involved 5831 people. The studies were conducted in countries around the world; most were done in Europe (25). All of these studies compared FLACS with PCS for people with cataracts. Sixteen of the studies were either funded by the manufacturer of the laser machine or the investigators reported financial links with the manufacturer. Overall, there was some uncertainty as to whether FLACS reduces the number of tears to the lens capsule because there were very few cases of capsule tears in both the manual and laser‐assisted cataract surgeries in these studies. Based on the data available, any difference in capsule complications is expected to be small. The capsule is a delicate membrane that originally covered the natural lens and holds the artificial lens following surgery. Tears in the capsule can adversely affect the visual outcomes following cataract surgery and may necessitate further surgery. Other complications were also infrequent for both laser‐assisted and standard cataract surgery. Based on the data available, any difference in postoperative visual outcomes is also expected to be small. Only three studies reported the effect of the operations on people’s quality of life and there is probably little or no difference when comparing FLACS and PCS. FLACS was the more expensive option and two studies reported that it was less cost‐effective. What are the limitations of the evidence? Our confidence in the evidence is low because of concerns about the fact that patients and assessors were aware of which treatment they were receiving or providing, respectively. Furthermore, not all of the studies provided data about everything we were interested in. Lastly, the evidence is also based on few cases of events in some areas. How up‐to‐date is this evidence? We searched for studies that had been published up to 10 May 2022.
【저자키워드】 humans, Cataract, macular edema, Phacoemulsification, lasers, Cataract Extraction, Cataract Extraction/adverse effects, Cataract/complications, Macular Edema/etiology, Phacoemulsification/adverse effects, Phacoemulsification/methods,