CHALLENGING CATARACT SURGERY IN VITRECTOMIZED EYES - COMPARING THE SURGICAL OUTCOMES OF FEMTOSECOND LASER ASSISTED CATARACT SURGERY VERSUS CONVENTIONAL PHACOEMULSIFICATION SURGERY: A SYSTEMATIC REVIEW
Keywords:
femtosecond laser-assisted cataract surgery, conventional phacoemulsification, vitrectomy, vitrectomized eyesAbstract
Introduction: Cataract formation is the most common long-term complication after vitrectomy, and cataract surgery in vitrectomized eyes is technically challenging because of altered ocular anatomy and increased risk of complications. Femtosecond laser-assisted cataract surgery (FLACS) may improve surgical precision and reduce intraoperative trauma compared with conventional phacoemulsification surgery (CPS). This systematic review compared the surgical outcomes of FLACS and CPS in vitrectomized eyes.
Method: A systematic review was conducted according to the PRISMA 2020 guidelines. PubMed, Cochrane Library and Science Direct were searched for RCTs, Clinical Trial , and observational studies involving adults (≥18 years) with previous vitrectomy undergoing FLACS or CPS. We assessed risk of bias using RoB 2.0 and ROBINS-I. Our outcomes were the visual acuity, ultrasound energy, Endothelial Cell Condition, surgery time, intraoperative and postoperative complication.
Results: We included 4 studies. Visual acuity improved in both groups, with comparable final corrected distance visual acuity. FLACS consistently reduced ultrasound energy requirements, cumulative dissipated energy and operative time. Higher postoperative endothelial cell density and lower endothelial cell loss were also reported with FLACS. Intraoperative complications, including posterior capsule rupture, dropped nucleus, anterior capsule tear, zonular dialysis, and silicone oil migration, occurred predominantly in the CPS group, whereas FLACS-related events were mainly limited to incomplete capsulotomy. Early postoperative corneal edema was less frequent with FLACS, while rates of cystoid macular edema, posterior capsule opacification, and anterior chamber inflammation were generally comparable.
Conclusion: FLACS provides superior intraoperative efficiency, better endothelial preservation, faster early visual recovery and a favorable safety profile compared with CPS in vitrectomized eyes, although final visual outcomes remain similar. Larger high-quality randomized studies are required to confirm these findings.
References
Do D V., Gichuhi S, Vedula SS, Hawkins BS. Surgery for post-vitrectomy cataract. Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd. 2013;2013(12). doi:10.1002/14651858.CD006366.pub3
Shousha MA, Yoo SH. Cataract surgery after pars plana vitrectomy. Curr Opin Ophthalmol. 2010;21(1):45-49. doi:10.1097/ICU.0b013e32833303bf
Chen DZ, Chee SP. Femtosecond laser-assisted cataract surgery for complex cataracts A review. Indian J Ophthalmol. Wolters Kluwer Medknow Publications. 2024;72(5):629-636. doi:10.4103/IJO.IJO_2996_23
Chen X, Zhong Y, Wang K, Xu J, Grzybowski A, Yao K. Femtosecond Laser-Assisted Cataract Surgery: Precision, Practice, and the Path to Personalization. Am J Ophthalmol. 2026;285:213-217. doi:10.1016/j.ajo.2026.01.031
Wen L, Lian H, Liu Y, et al. Effect of femtosecond laser-assisted cataract surgery for cataracts after pars plana vitrectomy: a prospective randomized controlled study. BMC Ophthalmol. 2025;25(1):79. doi:10.1186/s12886-025-03871-w
Asif MI, Sinha R, Anjum S, et al. Comparison of clinical outcomes between femtosecond laser-assisted cataract surgery versus conventional phacoemulsification in vitrectomized eyes – A prospective interventional study. Indian J Ophthalmol. 2024;72(9):1285-1290. doi:10.4103/IJO.IJO_1804_23
Cai L, Ma D, Xu X, et al. Comparative study of FLACS vs conventional phacoemulsification for complex cataracts in vitrectomized eyes. J Cataract Refract Surg. 2022;48(12):1381-1387. doi:10.1097/j.jcrs.0000000000000998
Wang EF, Worsley A, Polkinghorne PJ. Comparative study of femtosecond laser-assisted cataract surgery and conventional phacoemulsification in vitrectomized eyes. Clin Exp Ophthalmol. 2018;46(6):624-629. doi:10.1111/ceo.13133
Ren Z, Ni Y, Ma Y, Liu L, Qin Y, Wu M. Determinants of cataract types following pars plana vitrectomy: roles of underlying diseases, age, surgery duration, and silicone oil tamponade. BMC Ophthalmol. 2026;26(1). doi:10.1186/s12886-026-04699-8
Lee BJ, Jun JH, Afshari NA. Challenges and outcomes of cataract surgery after vitrectomy. Curr Opin Ophthalmol. Lippincott Williams and Wilkins. 2025;36(1):70-75. doi:10.1097/ICU.0000000000001096
Hernandez-Bogantes E, Abdala-Figuerola A, Olivo-Payne A, Quiros F, Wu L. Cataract Following Pars Plana Vitrectomy: A Review. Semin Ophthalmol. Taylor and Francis Ltd. 2021;36(8):824-831. doi:10.1080/08820538.2021.1924799
Markatia Z, Hudson J, Leung EH, Sajjad A, Gibbons A. The Postvitrectomy Cataract. Int Ophthalmol Clin. 2022;62(3):79-91. doi:10.1097/IIO.0000000000000440
Yeh CY, Fang HS, Ou YC, Cheng CK, Wu TE. Comparison of low-energy FLACS and conventional cataract surgery: meta-analysis and systematic review. J Cataract Refract Surg. Lippincott Williams and Wilkins. 2024;50(10):1074-1082. doi:10.1097/j.jcrs.0000000000001501
Wang H, Chen X, Xu J, Yao K. Comparison of femtosecond laser-assisted cataract surgery and conventional phacoemulsification on corneal impact: A meta-analysis and systematic review. PLoS One. 2023;18(4 APRIL). doi:10.1371/journal.pone.0284181
Biró Z, Kovacs B. Results of Cataract Surgery in Previously Vitrectomized Eyes. Vol 28. 2002.
Chang MA, Parides MK, Chang S, Braunstein RE. Outcome of Phacoemulsification after Pars Plana Vitrectomy. Vol 109. 2002.
Soliman MK, Hardin JS, Jawed F, et al. A Database Study of Visual Outcomes and Intraoperative Complications of Postvitrectomy Cataract Surgery. Ophthalmology. 2018;125(11):1683-1691. doi:10.1016/j.ophtha.2018.05.027
Narayan A, Evans JR, O’Brart D, Bunce C, Gore DM, Day AC. Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery. Cochrane Database of Systematic Reviews. 2023;2023(6). doi:10.1002/14651858.CD010735.pub3
Xu J, Chen X, Wang H, Yao K. Safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract: A meta-analysis and systematic review. Advances in Ophthalmology Practice and Research. Elsevier Inc. 2022;2(1). doi:10.1016/j.aopr.2022.100027
Day AC, Burr JM, Bennett K, et al. Femtosecond laser-assisted cataract surgery compared with phacoemulsification: The FACT non-inferiority RCT. Health Technol Assess (Rockv). 2021;25(6):a-94. doi:10.3310/HTA25060
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Gita Noor Azizah, Erlin Prawita Sari, Putty Nabilla, Arsil Abdan (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors publishing here keep copyright but grant the journal first publication rights, under a Creative Commons Attribution-NonCommercial 4.0 License. They can distribute their work non-exclusively elsewhere with an acknowledgment of its first publication in this journal. Posting the work online before and during submission for earlier and greater citation is encouraged, reflecting Open Access benefits.
