Comparison of Clinical Outcomes Between Femtosecond Laser-assisted Cataract Surgery and Phacoemulsification in Patients with Diabetes: A Systematic Review.

This article systematically review and compare the efficacy and safety of femtosecond laser-assisted cataract surgery (FLACS) and traditional phacoemulsification (PE) in patients with diabetes. A systematic search was conducted in Scopus, PubMed, Cochrane Library, and Google Scholar from inception to December 2024. Studies comparing FLACS with PE in patients with diabetes were included. The primary outcomes were central corneal thickness (CCT) and endothelial cell density (ECD), while the secondary outcomes included effective phaco time (EPT), surgical complications, and visual outcomes. The Cochrane Risk of Bias Tool 2.0 was used to assess quality in randomized controlled trials (RCTs), ROBINS-I for cohort studies, and the Newcastle-Ottawa scale for retrospective studies. Six studies involving 345 eyes met the inclusion criteria: one RCT, two cohort studies, one prospective study, and two retrospective studies. In the RCT, FLACS demonstrated significantly higher postoperative ECD compared to PE (mean difference: 423.55 cells/mm²; 95% CI: 199.89 to 647.21; P < 0.001). One cohort study reported EPT values of 6.52 ± 4.93 seconds for FLACS and 5.63 ± 4.31 seconds for PE. No significant differences in CCT were observed between groups at 3 months postoperatively across multiple studies. One study reported a lower incidence of postoperative complications, including fibrin exudation, corneal edema, posterior synechiae, and pigment dispersion, in the FLACS group, although specific rates were not provided. Overall, FLACS demonstrated superior endothelial cell preservation and a favorable safety profile in patients with diabetes; however, the available evidence is limited by study heterogeneity and risk of bias. Large-scale randomized controlled trials with standardized outcome reporting are needed.