Femtosecond lasers in ophthalmology: Mechanisms, clinical breakthroughs, and multidisciplinary frontiers

Femtosecond laser (FSL) technology has emerged as a transformative force in ophthalmology, offering unprecedented precision in tissue manipulation with minimal collateral thermal and mechanical damage. This comprehensive review traces the evolution of FSL from its fundamental physical principles to its broad spectrum of clinical applications. We examine its roles in refractive surgery, corneal transplantation, presbyopia correction, cataract surgery, glaucoma management, and pterygium excision, as well as recent advancements in intraocular lens customization and nanopatterning. Beyond established clinical use, we explore emerging frontiers where FSL intersects with optogenetics, two-photon photodynamic therapy, and artificial intelligence-augmented optical coherence tomography. Unresolved challenges, including reactive oxygen species-mediated toxicity, cost limitations, and long-term biosafety, are critically discussed. By integrating mechanistic insights, clinical evidence, and translational prospects, this review highlights the potential of FSL to redefine ophthalmic practice through interdisciplinary innovation and to enable the development of personalized, minimally invasive therapeutic strategies.