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Mathalone N, Ben-Shaul O, Podkovyrin O, Lux C, Geyer O. The Impact of Femtosecond Laser on Intraocular Pressure With Cataract Surgery in Healthy Eyes. J Glaucoma. 2025 Jan 1;34(1):19-24. doi: 10.1097/IJG.0000000000002491. Epub 2024 Aug 28. PMID: 39190421.
Abstract
Prcis: Femtosecond laser-assisted cataract surgery (FLACS) leads to an increase in intraocular pressure (IOP) during the procedure and subsequent IOP reduction after surgery, with greater magnitude in eyes with higher preoperative IOP.
Purpose: To evaluate the effect of FLACS using the LDVZ8 laser on IOP during and after surgery, and to compare the IOP-lowering effect of FLACS and conventional phacoemulsification cataract surgery (CPCS).
Patients and methods: This prospective cohort study enrolled 395 healthy eyes (395 patients) scheduled for FLACS (n=245) and CPCS (n=150). FLACS was performed using the LDVZ8 laser. During FLACS, IOP was assessed before and immediately after docking. IOP reduction during a 6-month postoperative period was evaluated following FLACS and CPCS. Multivariate analyses were performed.
Results: The mean IOP increase after docking was 2.3±4.1 mm Hg ( P <0.0001); the maximum increase was 17.6 mm Hg, peak of 38 mm Hg. Sixty-one eyes (25.1%) demonstrated an increase of ≥5 mm Hg and 10 (3.7%) showed an increase of ≥10 mm Hg; predocking IOP was associated with an IOP increase of ≥5 mm Hg ( P =0.029). IOP reduction over 6 months postsurgery was similar for FLACS and CPCS ( P >0.05), -1.33±3.12 mm Hg for FLACS ( P <0.001) and -1.4±2.87 mm Hg for CPCS ( P <0.001). Preoperative IOP correlated statistically significantly with IOP reduction in both FLACS (β -0.742, P <0.001) and CPCS (β -0.743, P <0.001).
Conclusions: Although the LDVZ8 laser procedure causes an increase in IOP in some healthy eyes, a subsequent decrease in IOP is observed after FLACS. The IOP-lowering effect of FLACS is similar to CPCS and tends to be more pronounced in eyes with higher preoperative IOP. Eyes with higher preoperative IOP are prone to IOP elevation during FLACS, a critical consideration for glaucoma patients.