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A prospective comparative study on endothelial cell loss and morphology after femtolaser-assisted cataract surgery and phacoemulsification

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To compare changes in endothelial cell count and morphology at 6 months follow-up in eyes undergoing femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification.


Prospective, comparative and open-label study.


All consenting patients between 50 and 75 years of age with uncomplicated cataract underwent either FLACS [Catalys Precision Laser System (OptiMedica Corp.; Abbott Medical Optics)] or conventional phacoemulsification [Bausch + Lomb Stellaris® (Rochester, USA)] based on their preference and were followed up on day 15 and at 2 and 6 months postoperatively. The endothelial cell count (ECC), % of hexagonal cells and coefficient of variation were noted at baseline and at each follow-up visit and compared between groups.


A total of 187 eyes of 187 patients (n = 98 in phaco vs. n = 89 in FLACS) were enrolled. At 15 days follow-up, there was a significant decline in the endothelial cell count in both groups (187 ± 156 in phaco vs. 193 ± 240 in FLACS, p < 0.001). In subsequent visits, the ECC remained stable (8% decline in phaco vs. 7.7% decline in femto, p = 0.87) till last follow-up at 6 months. The %hexagonal cells also decreased significantly at 15 days post-op (p < 0.001) but did not show any change in subsequent visits. The coefficient of variation in ECC did not change significantly throughout the study period. Eyes with higher endothelial cell count at baseline tended to lose more cells (b = 25.7 cells/mm3, 95% CI 16–35 cells, p = 0.01) irrespective of age and type of surgery.


Both procedures are equally safe with < 10% ECC loss at 6 months. Longer studies are required to determine influence of FLACS on ECC.

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Correspondence to Jai Kelkar.

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Kelkar, J., Kelkar, A., Pandit, A. et al. A prospective comparative study on endothelial cell loss and morphology after femtolaser-assisted cataract surgery and phacoemulsification. Int Ophthalmol (2020).

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  • Femtosecond laser-assisted cataract surgery (FLACS)
  • Endothelial cell count (ECC)
  • Phacoemulsification
  • Hexagonal cells