Abstract
PURPOSE: To compare the surgical outcomes of femtolaser-assisted cataract surgery (FLACS) vs. conventional phacoemulsification (CP) in nanophthalmic eyes. SETTING: Tertiary eye care Hospital. DESIGN: Randomized controlled trial (RCT). Computer-generated randomization was done. METHODS: We included 20 eyes of 20 nanophthalmic patients with visually significant cataracts and randomized them to undergo FLACS or CP. We included only one eye of each patient from each group, choosing the eye with worse visual acuity. RESULTS: The median corrected distance visual acuity (CDVA) improved significantly from baseline in both groups at all postoperative visits. The FLACS group showed a significant reduction in retinochoroidal scleral (RCS) thickness compared to the CP group at the 3rd-month postoperative visit (P = 0.002). The percentage of endothelial cell loss (ECL) was lower in FLACS (7.2) than CP (11.9) at 1-month follow-up (P = 0.247) and equal at 3 months (13.25 and 13.6 in FLACS and CP, respectively, P = 0.428). The median total surgical time in FLACS was significantly lower than the CP group (10 vs. 25.5, P = 0.034), and the median cumulative dissipative energy (CDE) was also lower in FLACS (6.65) than CP (8.46), though this difference was not statistically significant (P = 0.495). CONCLUSION: Both FLACS and CP are equally safe surgeries, causing significant improvement in postoperative visual acuity in nanophthalmic eyes. FLACS, however, had greater RCS reduction than CP and also required significantly lesser surgical time and lower CDE than CP. FLACS was also slightly more beneficial in protecting the endothelium in short eyes.