ARTICLE

Femtosecond laserassisted cataract surgery

versus standard phacoemulsification
cataract surgery: Outcomes and safety
in more than 4000 cases at a single center
Robin G. Abell, MB BS, Erica Darian-Smith, Jeffrey B. Kan, MB BS, Penelope L. Allen, PhD,
Shaun Y.P. Ewe, MB BS, Brendan J. Vote, FRANZCO

PURPOSE: To compare the intraoperative complications and safety of femtosecond laserassisted

cataract surgery and conventional phacoemulsification cataract surgery.
SETTING: Single center.
DESIGN: Prospective consecutive comparative cohort case series.
METHODS: Eyes had femtosecond laserassisted cataract surgery (study group) or phacoemulsi-
fication (control group) by 1 of 5 surgeons. The technique comprised manual corneal incisions and
capsulorhexis or laserassisted anterior capsulotomy, lens fragmentation, corneal incisions,
phacoemulsification, and intraocular lens implantation.
RESULTS: The study group comprised 1852 eyes and the control group, 2228 eyes. Patient demo-
graphics were similar between groups. There was a significant improvement in vacuum/docking at-
tempts, surface recognition adjustments, treatment, and vacuum time during the laser procedure in
the study group. Anterior capsule tears occurred in 1.84% of eyes in the study group and 0.22% of
eyes in the control group (P < .0001). There was no difference in the incidence of anterior capsule tears
between the first half and second half of laser-assisted cases. Anterior capsulotomy tags occurred in
1.62% study group eyes. There was no significant difference in posterior capsule tears between the 2
groups (0.43% versus 0.18%). The incidence of significant intraoperative corneal haze and miosis was
higher and the effective phacoemulsification time significantly lower in the study group (P < .001).
CONCLUSIONS: Significant intraoperative complications likely to affect refractive outcomes and
patient satisfaction were low overall. The 2 cataract surgery techniques appear to be equally safe.
Although anterior capsule tears remain a concern, the safety of femtosecond-assisted cataract
surgery in terms of posterior capsule complications was equal to that of phacoemulsification.
Financial Disclosure: No author has a financial or proprietary interest in any material or method
mentioned.
J Cataract Refract Surg 2015; 41:4752 Q 2015 ASCRS and ESCRS

The application of femtosecond lasers in cataract surgery
allows creation of automated corneal incisions, anterior
capsulotomy, and lens fragmentation.1 Ultrashort-pulse
femtosecond lasers operate at near infrared wavelengths
and can be focused precisely at predetermined depths
using advanced imaging technology to photodisrupt
optically clear tissues while preventing collateral tissue
damage.2 The advantages of this technology over
conventional phacoemulsification, including a more
consistent capsulotomy and a significant reduction in
phacoemulsification energy requirements,35 have the
potential to improve refractive outcomes.
Despite reports of the safety and efficacy of femto-
second laserassisted cataract surgery in a noncom-
parative large consecutive case series,6 surgeons
remain concerned about adopting this technology
and about the potential learning curve.7 To date, there
have been no large comparative cohort or randomized

Q 2015 ASCRS and ESCRS http://dx.doi.org/10.1016/j.jcrs.2014.06.025 47

Published by Elsevier Inc. 0886-3350
48 FEMTOSECOND LASER VERSUS PHACOEMULSIFICATION
studies in the peer-reviewed literature. In this study,
we analyzed a large cohort of patients from a single
center to compare intraoperative complication rates
between femtosecond laserassisted cataract surgery
and conventional manual phacoemulsification cata-
ract surgery.
PATIENTS AND METHODS
This prospective consecutive comparative cohort study
comprised femtosecond laserassisted cataract surgery cases
(study group) and phacoemulsification cataract surgery
cases (control group) performed at a single center between
May 2012 and November 2013. The study conformed to
the Declaration of Helsinki and its subsequent revisions,
and ethics approval was obtained from the Tasmanian
Human Research and Ethics Committee (HREC H12534).
Patients who had no contraindications to femtosecond
laserassisted cataract surgery were offered the surgery at
an out-of-pocket cost of A$750. Contraindications included
age younger than 22 years, extensive corneal scarring,
corneal ring inlays, past glaucoma filtration surgery, and
previous refractive surgery. Patients with ocular comorbid-
ities that were unlikely to affect surgical performance were
included in the study. Eyes with previous trauma or deemed
likely to be challenging (eg, small pupil, floppy-iris syn-
drome, intumescent cataract) were more likely to have
manual phacoemulsification cataract surgery based on sur-
geon preference, although these factors were relative contra-
indications to femtosecond laserassisted cataract surgery
only.
Preoperative Assessment
All patients had a comprehensive baseline preoperative
assessment. Anterior segment examinations and posterior
segment examinations were performed with undilated
pupils and dilated pupils, respectively. Biometry was per-
formed a maximum of 6 months before surgery. Axial
length, anterior chamber depth, and biometry were deter-
mined using partial coherence interferometry (IOLMaster
4, Carl Zeiss Meditec AG). Other evaluations included opti-
cal coherence tomography (OCT) (Stratus, Carl Zeiss Medi-
tec AG), specular microscopy (EM-3000, Tomey Corp.),
corneal pachymetry with a Scheimpflug imaging system
(Pentacam, Oculus Optikgerate GmbH), and corneal topog-
raphy (OPD-Scan II, Nidek Co., Ltd.). The Scheimpflug im-
aging system was used to objectively assess the cataract
grade.8 The system uses densitometry software to evaluate
lens volume and optical density and grade cataracts on a nu-
cleus staging scale of 0 to 5.
Submitted: February 9, 2014.
Final revision submitted: June 16, 2014.
Accepted: June 17, 2014.
From the Tasmanian Eye Institute (Abell, Darian-Smith, Kan, Allen,
Ewe, Vote) and the Launceston Eye Institute (Vote), Tasmania,
Australia.
Corresponding author: Brendan J. Vote, FRANZCO, Launceston Eye
Institute, 36 Thistle Street West, Launceston 7250, Australia.
E-mail: eye.vote@bigpond.net.au.
J CATARACT REFRACT SURG - VOL 41, JANUARY 2015
Preoperatively, all patients were instructed to instill topical
ketorolac and topical chloramphenicol for the 2 days preced-
ing the procedure. After admission on the day of surgery, all
patients received topical anesthesia and their pupil was
dilated with a gel formulation consisting of phenylephrine
2.5%, cyclopentolate 1.0%, tropicamide 1.0%, lidocaine hydro-
chloride jelly 2.0% (Xylocaine), and diclofenac 0.1%.
Laser Parameters and Settings
The Catalys Precision Laser System with a liquid-optics pa-
tient interface (Abbott Medical Optics, Inc.) was used in the
study group. This diode-pumped solid-state femtosecond
laser operates at a wavelength of 1030 nm and pulse duration
of 600 fs. The laser settings were consistent for the duration of
the study. The software versions were up to date at the time of
the study. Corneal incision modules were installed with a soft-
ware upgrade in December 2012, which reduced the time
taken for anterior capsulotomy. For corneal incisions, the
main wound and 2 side-port settings, respectively, were as fol-
lows: limbal offsets 0.3 mm and 0.4 mm, width 2.7 mm and 1.3
mm, length 1.8 mm and 1.2 mm, and pulse energy 5 mJ and 6
mJ. The other settings were anterior plane depth 40%, posterior
plane depth 70%, anterior side-cut angle 75 degrees, and pos-
terior side-cut angle 45 degrees for the main wound and the
side port. For anterior capsulotomy, the incision depth was
600 mm, the horizontal spot spacing was 5 mm, the vertical
spot spacing was 10 mm, and the pulse energy was 4 mJ. For
lens fragmentation, the posterior capsule safety zone was
500 mm, the horizontal spot spacing was 10 mm, the vertical
spot spacing was 40 mm, and the pulse energy was 8 mJ anteri-
orly and 10 mJ posteriorly.
Surgical Technique
Cataract surgery was performed by 1 of 5 surgeons. In the
study group, the femtosecond laser portion was performed
in a separate room adjacent to the operating room. Prede-
fined surgeon templates were used for the selection of
anterior capsulotomy and lens fragmentation patterns. All
surgeons performed 10 accreditation cases before the begin-
ning of the study. Lens fragmentation patterns were altered
during later cases to permit analysis of improvements in ease
of cataract extraction. The surgeon confirmed the accuracy,
location, and size of the corneal incisions, anterior capsulot-
omy, and lens fragmentation architecture before laser treat-
ment using high-resolution video and anterior segment
spectral-domain OCT imaging. The OCT imaging also al-
lowed the detection of posterior capsule and iris margin
safety zones. After the laser procedure, the number of vac-
uum attempts, docking attempts, troubles with vacuum or
docking, treatment time, vacuum time, and OCT adjust-
ments required were recorded. The patient was then trans-
ferred to the operating room for regional anesthesia and
completion of surgery.
Intraoperatively, corneal incisions were opened using a
flap lifter (6-858 Stevens Femto Flap Lifter, Duckworth &
Kent) in the study group or manually using a 2.25 to
2.75 mm keratome and 1.20 mm side-port blade in the control
group. The anterior chamber was filled with sodium hyalur-
onate 3.0%chondroitin sulfate 4.0% (Viscoat) in both
groups. In the study group, the anterior capsule was
removed using a capsulorhexis forceps following the contour
of the laser capsulotomy in a continuous curvilinear fashion.
Subsequently, cautious hydrodissection was performed,
ensuring the release of intracapsular gas, using low volumes
 FEMTOSECOND LASER VERSUS PHACOEMULSIFICATION
of fluid, and avoiding exertion of excessive pressure through
the cannula (to prevent capsule block). In the control group,
the continuous curvilinear capsulorhexis (CCC) was created
with a capsulorhexis forceps. Lens segmentation was per-
formed using a divide-and-conquer approach. Surgery was
then completed in both groups using standard phacoemulsi-
fication procedures (Megatron, Geuder AG) followed by
intraocular lens (IOL) implantation in the capsular bag after
successful removal of the lens cortex.
Intraoperative complications were recorded on the sur-
gery report and included the presence of corneal haze
affecting the surgical view at any timepoint not due to a pre-
existing condition, laser-induced miosis, anterior capsuloto-
my tag, anterior capsule tear, posterior capsule tear,
posterior capsule rupture, and IOL dislocation.
Statistical Analysis
Statistical analyses were performed using SPSS software
(version 19, International Business Machines Corp.). For
comparison of baseline demographics and clinical character-
istics between groups, categorical data were analyzed using
the Fisher exact test and continuous data using paired t tests.
Differences were accepted as significant when the P value
was less than 0.05.
RESULTS
The study evaluated 4080 eyes, 1852 eyes in the study
group and 2228 eyes in the control group. Patient demo-
graphics and baseline characteristics were similar be-
tween groups. In particular, there was no significant
between-group difference in ocular comorbidities, intra-
operative pupil size, cataract grade, or age of patients.
The mean age was 73.5 years G 9.5 (SD) in the study
group and 72.6 G 9.6 years in the control group. Nucleus
staging using the Scheimpflug system showed a mean
cataract grade of 2.81 G 0.65 in the study group and
2.80 G 0.71 in the control group. One thousand thirty-
seven eyes (56%) in the study group and 1225 eyes
(55%) in control group were women.
All aspects of the laser procedure improved with
surgeon experience. There was a statistically signifi-
cant improvement in docking attempts, image/OCT
surface-recognition adjustments, and treatment time
during the laser procedure in the second half of cases
(Table 1). Some improvements reflected the benefits
of software upgrades during the study.
Table 2 shows the intraoperative complications. The
incidence of anterior capsule tears and anterior capsu-
lotomy tags was statistically significantly higher in the
study group than in the control group (P ! .0001).
Although the incidence of posterior capsule tears was
higher in the study group, the difference between
groups was not statistically significant. One case of ante-
rior capsule tear in each group extended to the posterior
capsule, requiring anterior vitrectomy; the remaining
cases proceeded uneventfully with IOL placement in
the bag. The incidence of significant intraoperative
J CATARACT REFRACT SURG - VOL 41, JANUARY 2015
49
Table 1. Comparison of laser procedure parameters between
first half of cases and second half of cases.
First Half Second Half
Variable of Cases of Cases P Value
Mean vacuum 1.25 G 0.61 1.26 G 0.58 NS
attempts (n)
Mean docking 1.35 G 0.69 1.28 G 0.68 .04
attempts (n)
OCT adjustments, n (%) 91 (12.1) 43 (5.7) .0001
Mean treatment time (s) 60.8 G 14.02 54.13 G 14.76 .0001
Vacuum time (min:sec) 3:27 G 0:43 3:23 G 0:44 NS
Means G SD
NS Z not significant; OCT Z optical coherence tomography
corneal haze affecting the surgical field view and intra-
operative miosis was statistically significantly higher in
the study group than in the control group (P ! .001).
The effective phacoemulsification time was statistically
significantly lower in the study group (P ! .0001). There
were no cases of posterior lens dislocation.
There was no difference in the incidence of anterior
or posterior capsule tears between the first half and
second half of femtosecond laserassisted cases
(c2(1) Z 1.3, P Z .3), suggesting the learning curve
had little effect on these parameters.
DISCUSSION
This large prospective single-center comparative
cohort study evaluated the safety and learning curve
of femtosecond laserassisted cataract surgery. We
found a statistically significantly higher rate of ante-
rior capsule tears in the femtosecond laserassisted
cataract surgery group, and this was not related to
the learning curve. There was, however, no between-
group statistically significant difference in complica-
tions such as posterior capsule tear and dropped
nucleus, which might be considered more clinically
relevant for refractive outcomes and patient satisfac-
tion. At present, there is a need for surgical bench-
marks with regard to laser cataract surgery
complications so surgeons can better inform their
patients of the risks and benefits of femtosecond
laserassisted cataract surgery.
Evidence-based guidelines for phacoemulsification
cataract surgery suggest that a capsule complication
rate of less than 2.0% should be achievable.9 The
incidence of anterior capsule tear in our study was
below this figure in the femtosecond laserassisted
group (1.84%) but was statistically significantly higher
than in our phacoemulsification cataract surgery
benchmark (0.22%) after 2228 cases. Published peer-
50 FEMTOSECOND LASER VERSUS PHACOEMULSIFICATION
Table 2. Between-group comparison of Intraoperative complications.
Number (%)
Complication Laser Assisted (n Z 1852)
Incomplete capsulotomy 21 (1.13)
Anterior capsulotomy tag 30 (1.62)
Anterior capsule tear 34 (1.84)
Posterior capsule tear 8 (0.43)
Corneal haze 12 (0.65)
Unstable pupil 30 (1.65)
Iris hooks/Malyugin ring 5 (0.27)
NA Z not applicable; NS Z not significant
reviewed research studies have yet to compare the
complication rates of femtosecond laserassisted cata-
ract surgery with concurrent phacoemulsification
cataract surgery, unlike our study of prospective
comparative cohorts. Case mix might account for the
differences between surgeons; therefore, we recom-
mend using objective measures of cataract densitom-
etry as has been previously reported.3,8,10
In both surgery groups, none of the eyes in which a
complication occurred were noted perioperatively to
have risk factors, such as a weak zonule, a shallow
anterior chamber, a small pupil, high vitreous pres-
sure, or poor visibility during surgery.11,12 We also
found no difference in cataract grade and age between
the 2 groups, and patients with complications were no
more likely to be older or have denser cataracts than
those without complications.
In a study by Roberts et al.,6 femtosecond laseras-
sisted cataract surgery complication rates decreased
after an initial combined learning curve of 200 cases.
The reduction in complicated cases was likely the
result of improvements in surgeon technique and
experience. In that study, anterior capsule tears were
more likely to result from a microtag being stretched
and torn during intracapsular manipulation, and the
authors recommended switching to high magnifica-
tion and inspecting the capsule edge before proceed-
ing to phacoemulsification. A recent study by
Arbisser et al.13 suggests using a CCC (central dimple
down) technique for removing the femtosecond
laserassisted cataract surgery capsulotomy. All sur-
geons in our study were familiar with the alterations
in intraoperative and capsule dynamics in femto-
second laserassisted cataract surgery and the
requirement for an adjustment of surgical maneu-
vers.3,6,14 This may have been a factor in why we
were unable to show a learning curve effect in our
femtosecond laserassisted cataract surgery cohort.
In fact, just over 50% of anterior radial and posterior
capsule tears occurred in the second half of cases in
J CATARACT REFRACT SURG - VOL 41, JANUARY 2015
Phacoemulsification (n Z 2228) P Value
NA NA
1 (0.004) .0001
5 (0.22) .0001
4 (0.18) NS
1 (0.04) .0009
14 (0.65) .003
1 (0.04) NS
the femtosecond laserassisted group. The only
improvement in the second half of femtosecond
laserassisted cataract surgery cases was a significant
reduction in anterior capsulotomy tags, which was
likely the result of a software upgrade that reduced
capsulotomy time considerably, resulting in a lower
chance of aberrant pulses due to eye movements.15
This suggests that the capsule complications of femto-
second laserassisted cataract surgery in our study
were not related to the surgeon learning curve but
rather to other effects that may be patient- or
surgery-related, as we have previously published.15
All cases of capsule tears were reviewed and deemed
to occur within the normal limits of a standard phaco-
emulsification procedure. In other words, no extra
stress to the capsule edge or accidental/inadvertent
pressure from instrumental movements was applied
beyond what would normally be expected in a stan-
dard case.
After more than 4000 cases, we can conclude that
the rate of posterior capsule tear was not statistically
significantly different between our femtosecond
laserassisted cataract surgery and phacoemulsifica-
tion cataract surgery cohorts, even though the result
was numerically greater in the femtosecond laser
cohort. Posterior capsule tears, unlike anterior
capsule tears, are more likely to affect the effective
lens position and hence the refractive outcome.16
They also can have a significant effect on endothelial
cell loss, glaucoma, cystoid macular edema, endoph-
thalmitis, and retinal detachment when anterior vit-
rectomy is required and surgical time prolonged.17
Patient satisfaction can also be hindered when signif-
icant procedural complications occur. The incidence
of posterior capsule tears in the literature varies be-
tween 0% and 4%.18 Our capsule complication rate
appears to be below the average reported in the liter-
ature,6,19,20 suggesting femtosecond laserassisted
cataract surgery is as safe as phacoemulsification
cataract surgery in terms of posterior capsule
 FEMTOSECOND LASER VERSUS PHACOEMULSIFICATION
complications. However, our results show a statisti-
cally significantly greater risk for anterior capsule
tears in femtosecond laserassisted cataract surgery
(1.84%) than in phacoemulsification cataract surgery
(0.22%). A case study of capsular block syndrome
(CBS)7 showed the potential for large volumes of in-
tracapsular gas to cause posterior capsule rupture
during hydrodissection and hence was the first study
to report the differences in fluid volumes, fluidics, in-
tracapsular dynamics, and their potential effect on in-
tracapsular manipulations. Only 1 of our cases of
posterior capsule tear in the femtosecond laser group
occurred as a result of CBS and in the first handful of
cases performed by the surgeon. The surgeon was
able to remove the lens in the anterior segment plane;
this was followed by anterior vitrectomy and IOL im-
plantation in the sulcus.
The safety of femtosecond laserassisted cataract
surgery has been reported in the short term.6 Early
studies of the short-term and long-term surgical out-
comes are also emerging,2127 and there may be an ef-
fect of a learning curve that we did not identify in our
study.6,19 Further research of the effect of femtosecond
laserassisted cataract surgery on the postoperative
intraocular pressure, corneal edema, endothelial cell
count, and macular thickness may indicate whether
the reduction in phacoemulsification energy and
replacement with femtosecond laser energy will lead
to improved safety and better outcomes.
In conclusion, significant intraoperative complica-
tions that are likely to affect refractive outcomes and
patient satisfaction were low in both groups. Femto-
second laserassisted cataract surgery appears to be
as safe as conventional phacoemulsification cataract
surgery. Although anterior capsule tears remain a
concern, the safety of femtosecond laserassisted cata-
ract surgery and phacoemulsification cataract surgery
was the same in terms of posterior capsule
complications.
WHAT WAS KNOWN
 Femtosecond laserassisted cataract surgery is as safe
and effective as conventional phacoemulsification cata-
ract surgery.
WHAT THIS PAPER ADDS
 Anterior capsule tears remain a concern; however, the
incidence of posterior capsule complications was similar
between the 2 surgical techniques.
 The effect of a learning curve on intraoperative complica-
tions was minimal.
J CATARACT REFRACT SURG - VOL 41, JANUARY 2015
51
REFERENCES
1. Palanker DV, Blumenkranz MS, Andersen D, Wiltberger M,
Marcellino G, Gooding P, Angeley D, Schuele G, Woodley B,
Simoneau M, Friedman NJ, Seibel B, Batlle J, Feliz R,
Talamo J, Culbertson W. Femtosecond laserassisted cataract
surgery with integrated optical coherence tomography. Sci
Transl Med 2010; 2:58ra85. Available at: http://www.stanford.
edu/wpalanker/publications/fs_laser_cataract.pdf. Accessed
August 20, 2014
2. Juhasz T, Loesel FH, Kurtz RM, Horvath C, Bille JF, Mourou G.
Corneal refractive surgery with femtosecond lasers. IEEE J Sel
Top Quant Electron 1999; 5:902910
3. Abell RG, Kerr NM, Vote BJ. Toward zero effective phacoemul-
sification time using femtosecond laser pretreatment. Ophthal-
mology 2013; 120:942948
4. Nagy Z, Takacs A, Filkorn T, Sarayba M. Initial clinical evalua-
tion of an intraocular femtosecond laser in cataract surgery.
J Refract Surg 2009; 25:10531060
5. Conrad-Hengerer I, Hengerer FH, Schultz T, Dick HB. Effect of
femtosecond laser fragmentation on effective phacoemulsifica-
tion time in cataract surgery. J Refract Surg 2012; 28:879883
6. Roberts TV, Lawless M, Bali SJ, Hodge C, Sutton G. Surgical
outcomes and safety of femtosecond laser cataract surgery; a
prospective study of 1500 consecutive cases. Ophthalmology
2013; 120:227233
7. Roberts TV, Sutton G, Lawless MA, Jindal-Bali S, Hodge C.
Capsular block syndrome associated with femtosecond laser
assisted cataract surgery. J Cataract Refract Surg 2011;
37:20682070
8. Magalha ~ es FP, Costa EF, Cariello AJ, Rodrigues EB, Hofling-
Lima AL. Comparative analysis of the nuclear lens opalescence
by the Lens Opacities Classification System III with nuclear density
values provided by Oculus Pentacam: a cross-section study using
Pentacam Nucleus Staging software. Arq Bras Oftalmol 2011;
74:110113. Available at: http://www.readcube.com/articles/
10.1590/S0004-27492011000200008. Accessed August 20, 2014
9. Lundstro m M, Behndig A, Kugelberg M, Montan P, Stenevi U,
Thorburn W. Decreasing rate of capsule complications in cata-
ract surgery: eight-year study of incidence, risk factors, and
data validity by the Swedish National Cataract Register.
J Cataract Refract Surg 2011; 37:17621767
10. Mayer WJ, Klaproth OK, Hengerer FH, Kohnen T. Impact of
crystalline lens opacification on effective phacoemulsification
time in femtosecond laser-assisted cataract surgery. Am J Oph-
thalmol 2014; 157:426432
11. Coelho RP, Paula JS, Rosatelli Neto JM, Vieira Messias AM.
Capsulorhexis rescue after peripheral radial tear-out: quick-
pull technique. J Cataract Refract Surg 2012; 38:737738
12. Palanker D, Nomoto H, Huie P, Vankov A, Chang DF. Anterior
capsulotomy with a pulsed-electron avalanche knife.
J Cataract Refract Surg 2010; 36:127132
13. Arbisser LB, Schultz T, Dick HB. Central dimple-down maneuver
for consistent continuous femtosecond laser capsulotomy.
J Cataract Refract Surg 2013; 39:17961797
14. Conrad-Hengerer I, Hengerer FH, Schultz T, Dick HB. Effect of
femtosecond laser fragmentation of the nucleus with different
softening grid sizes on effective phaco time in cataract surgery.
J Cataract Refract Surg 2012; 38:18881894
15. Abell RG, Davies PEJ, Phelan D, Goemann K, McPherson ZE,
Vote BJ. Anterior capsulotomy integrity after femtosecond laser-
assisted cataract surgery. Ophthalmology 2014; 121:1724
16. Chan E, Mahroo OAR, Spalton DJ. Complications of cataract
surgery. Clin Exp Optom 2010; 93:379389. Available at: http://
onlinelibrary.wiley.com/doi/10.1111/j.1444-0938.2010.00516.x/
pdf. Accessed August 20, 2014
52 FEMTOSECOND LASER VERSUS PHACOEMULSIFICATION
17. Stefaniotou M, Aspiotis M, Pappa C, Eftaxias V, Psilas K. Timing
of dislocated nuclear fragment management after cataract sur-
gery. J Cataract Refract Surg 2003; 29:19851988
18. Ionides A, Minassian D, Tuft S. Visual outcome following posterior
capsule rupture during cataract surgery. Br J Ophthalmol 2001;
85:222224. Available at: http://www.pubmedcentral.nih.gov/
picrender.fcgi?artidZ1723855&blobtypeZpdf. Accessed August
20, 2014
19. Nagy ZZ, Takacs AI, Filkorn T, Kra  nitz K, Gyenes A, Juha
sz E,
Sa ndor GL, Kovacs I, Juha sz T, Slade S. Complications of
femtosecond laserassisted cataract surgery. J Cataract
Refract Surg 2014; 40:2028
20. Bali SJ, Hodge C, Lawless M, Roberts TV, Sutton G. Early expe-
rience with the femtosecond laser for cataract surgery. Ophthal-
mology 2012; 119:891899
21. Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM,
Galloway P, Canning C; Sparrow JM and the UK EPR user
group. The Cataract National Dataset electronic multicentre
audit of 55 567 operations: updating benchmark standards of
care in the United Kingdom and internationally. Eye 2009;
23:3849. Available at: http://www.nature.com/eye/journal/
v23/n1/pdf/6703015a.pdf. Accessed August 20, 2014
22. Filkorn T, Kovacs I, Taka  Horva
cs A,  Knorz MC, Nagy ZZ.
th E,
Comparison of IOL power calculation and refractive outcome
J CATARACT REFRACT SURG - VOL 41, JANUARY 2015
after laser refractive cataract surgery with a femtosecond laser
versus conventional phacoemulsification. J Refract Surg 2012;
28:540544
23. Conrad-Hengerer I, A.I.Juburi M, Schultz T, Hengerer FH,
Dick HB. Corneal endothelial cell loss and corneal thickness in
conventional compared with femtosecond laserassisted cata-
ract surgery: three-month follow-up. J Cataract Refract Surg
2013; 39:13071313
24. Abell RG, Allen PL, Vote BJ. Anterior chamber flare after femto-
second laserassisted cataract surgery. J Cataract Refract Surg
2013; 39:13211326
25. Abell RG, Kerr NM, Vote BJ. Femtosecond laser-assisted cata-
ract surgery compared with conventional cataract surgery. Clin
Exp Ophthalmol 2013; 41:455462
26. Taka  Kova
cs AI cs I, Miha
ltz K, Filkorn T, Knorz MC, Nagy ZZ.
Central corneal volume and endothelial cell count following
femtosecond laser-assisted refractive cataract surgery
compared to conventional phacoemulsification. J Refract Surg
2012; 28:387391
27. Szigeti A, Kra nitz K, Takacs AI, Miha ltz K, Knorz MC, Nagy ZZ.
Comparison of long-term visual outcome and IOL position with
a single-optic accommodating IOL after 5.5- or 6.0-mm
femtosecond laser capsulotomy. J Refract Surg 2012; 28:
609613