Factors Associated With Postoperative Outcomes in Femtosecond Laser-Assisted Cataract Surgery

Background This study aimed to assess the postoperative outcomes of patients who underwent femtosecond laser-assisted cataract surgery (FLACS) and the demographic and clinical factors associated with favorable visual outcomes. Methodology We conducted a secondary data analysis of 162 eyes from 145 patients at a tertiary eye hospital from January 2020 to August 2022. We collected pre and postoperative (one month) visual and refractive outcomes. We calculated the postoperative efficacy using the following formula: 1 - (postoperative cylinder - preoperative anticipated cylinder)/(preoperative cylinder - preoperative anticipated cylinder) × 100. Results The mean (SD) age of the study population was 64.9 (8.5) years. There was a significant change in the preoperative cylinder compared with the postoperative cylinder (-0.66 (-0.80, -0.56) D vs. 0 (-0.50, 0) D; p < 0.001). Postoperatively, about 69.8% (113) had an absolute cylinder of ≤0.25 D, 19.8% (32) had a cylinder of >0.25-0.50 D, and the remaining 10.5% (17) had a cylinder of >0.50 D. The median (interquartile range) preoperative cylinder was significantly different in the >0.50 D group compared with ≤0.25 D group (-0.80 (-1.00, -0.62) D vs. -0.65 (-0.75, -0.54) D; p < 0.001). The mean (SD) efficacy of the procedure was 72.2% (47.3%). The anterior eccentricity values at 8 mm chords were significantly different in the lower efficacy group and higher efficacy group (0.46 (0.29, 0.55) vs. 0.53 (0.42, 0.61); p = 0.04). The proportion of eyes with less than 100% efficacy was significantly higher in those with against-the-rule astigmatism compared with oblique and with-the-rule astigmatism (43.6% vs. 24.0%; p = 0.009). Conclusions The majority of the eyes operated with FLACS had postoperative astigmatism of less than or equal to 0.25 D and 100% postoperative efficacy, with no major complications. Lower efficacy of the procedure was associated with higher preoperative cylinder, length of the arc, lower eccentricity of the cornea, and against-the-rule astigmatism.