PURPOSE: To investigate the amount of endothelial cell loss (ECL) and refractive predictability by femtosecond laser-assisted cataract surgery (FLACS) compared to conventional phacoemulsification cataract surgery (CPS).

METHODS: Forty-seven patients had one eye operated by FLACS and the contralateral eye operated by CPS (stop and chop technique). Both eyes had intraocular aspheric lenses implanted. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), central corneal endothelial cell count and hexagonality with a non-contact specular microscope were assessed preoperatively, 1-3 days postoperatively and 3 months postoperatively.

RESULTS: Three days postoperatively, mean ECL was 249 cells/mm(2) (SD ± 744) (9.1%) by FLACS and 235 cells/mm(2) (SD ± 681) (8.2%) by CPS (p = 0.87). Three months postoperatively, mean ECL was 274 cells/mm(2) (SD ± 358) (11.4%) by FLACS compared with 333 cells/mm(2) (SD ± 422) (13.9%) by CPS, (p = 0.30) 3 months postoperatively, hexagonality was decreased by 1.8% (SD ± 30) by FLACS and by 1.4% (SD ± 13) by CPS, (p = 0.84). The mean absolute difference from the attempted refraction was 0.37 dioptres (D) (SD ± 0.33) by FLACS and 0.41 D (SD ± 0.42) by CPS (p = 0.56). Mean CDVA was 0.89 (0.3; 1.25) by FLACS and 0.93 (0.4; 1.25) by CPS at 3 months postoperatively (p = 0.36). Within both groups, 70% gained a CDVA of 6/6. Mean surgery time was 9.3 min (SD ± 1.9) by FLACS and 8.0 min (SD ± 1.9) by CPS, (p = 0.0018). Mean phaco energy was 3.78 U/S (SD ± 5.1) and 5.45 U/S (SD ± 4.6) (p < 0.0001) by FLACS and CPS, respectively.

CONCLUSION: We found no significant difference in ECL and refractive predictability between FLACS and CPS 3 months postoperatively.