Reply: Comparison of femtosecond laser–assisted cataract surgery and conventional cataract surgery: a meta-analysis and systematic review.

Abstract

With interest, we read the letter to the editor from Levitz et al. and would like to thank them for pointing out important aspects discussed in our article.1 We agree that focusing on differences between the several laser systems in femtosecond laser–assisted cataract surgery (FLACS) is important. In our analysis, all cases of posterior capsule ruptures (PCR) with FLACS were reported using the Catalys or LenSx laser systems. Furthermore, it should be noted that all cases in the Catalys subgroup appeared in 2 Australian centers. Thus, it is possible that they had used certain laser settings that caused a higher rate of PCR. It is also important to mention the absence of PCR with FLACS in our subgroup analysis of randomized controlled trials. The assumption of PCR to occur less during FLACS is confirmed by the recent randomized controlled study by Roberts et al., which did not report any PCR or vitreous loss using the LenSx laser.2 Another important aspect mentioned by Levitz et al. is to consider FLACS in difficult cases because the critical steps in conventional surgery seemed to be facilitated using the laser.2 Even in the first cases of laser surgery, complications rarely occur.3,4 In summary, there are noteworthy advantages of FLACS compared with conventional cataract surgery, such as higher precision and less damage of ambient structures. Even better results of laser surgery, especially a reduction of complication rates, might be expected with more clinical experience and further developed laser systems.

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