Outcomes of Resident-Performed Laser-Assisted vs Traditional Phacoemulsification.

PURPOSE To compare the effectiveness of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPS) by resident surgeons. SETTING Parkland Memorial Health and Hospital System, Dallas, Texas, U.S.A. DESIGN Prospective randomized study. METHODS All surgeries to be performed by PGY-3 & 4 residents from October 2015 through June 2017 were eligible for inclusion. Patients were required to complete a post-op day 1, week 1, month 1, and month 3 visit. Specular microscopy was performed preoperatively and post-operatively. Surgeries were filmed and each step timed and compared. Surgeon and patient surveys were filled out post-operatively. RESULTS Of the 135 eyes of 96 subjects enrolled in the study, 64 eyes received FLACS and 71 eyes received CPS. There was no significant difference in best corrected visual acuity (BCVA), either preoperatively or at the postop day 1, week 1, month 1, or month 3 visits (P= 0.469, 0.539, 0.701, 0.777, and 0.777 respectively). Cumulated dissipated energy and irrigation fluid usage were not different between FLACS and CPS (P-values 0.521 and 0.368), nor was there a difference n the reduction of endothelial cell counts after surgery (P=0.881). Wound creation (P=0.014), cortical cleanup (P=0.009) and IOL implantation (P=0.031) were faster in the CPS group. Survey results indicated that the overall patient experience was similar for FLACS and CPS. CONCLUSION This first prospective randomized trial evaluating resident-performed FLACS shows that, in resident hands, FLACS provides similar results to CPS with regards to visual acuity, endothelial cell loss, operative time, patient satisfaction, and surgical complication rate.