Author’s Name(s): Moncef Berkache, Wissam Nassrallah, Mohammad Karam, Kenan Bachour, Allison Bernstein, Mona Harissi-Dagher, Samir Jabbour

Author’s Disclosure Block: Moncef Berkache, none; Wissam Nassrallah, none; Mohammad Karam, none; Kenan Bachour, none; Allison Bernstein, none; Mona Harissi-Dagher, none; Samir Jabbour, none

Abstract Body
Purpose: Patients with Fuchs’ endothelial dystrophy (FED) are at a higher risk of endothelial cell loss during cataract surgery. This study aims to determine whether conventional phacoemulsification (phaco) or femtosecond laser-assisted cataract surgery (FLACS) offers better outcomes in terms of visual acuity and central corneal thickness post-surgery. Study Design: Systematic review and Meta-analysis. Methods: An electronic search was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Embase and Cochrane CENTRAL were systematically searched for studies comparing outcomes of FLACS vs phaco surgery in patients with Fuchs’ endothelial dystrophy. Primary outcomes included best corrected distance visual acuity (CDVA), central corneal thickness (CCT), and endothelial cell density (ECD). Data was analysed using a random-effects model with Hedges g to measure effect sizes. Hedge’s g and 95% confidence intervals are reported. Results: Our initial search strategy yielded 316 articles. They were screened by two independent reviewers down to 21 studies, after which 16 were rejected. Data extraction was done by two research fellows. 408 eyes that underwent phaco and 251 eyes that underwent FLACS were included in this meta-analysis. Pre-operative CDVA was worse in the phaco group (Hedge’s g: 0.166 [0.08, 0.48]) though postoperative CDVA within a 3-month follow-up period was identical between phaco and FLACS groups (Hedge’s g: 0.116 [-0.044, 0.276]). Both phaco and FLACS groups saw an increase in CCT postoperatively within a 1-month follow-up period (phaco: Hedge’s g: -0.902 [-1.568, -0.235]; FLACS: Hedge’s g: -0.520 [-0.863, -0.176]). ECD was significantly decreased in the phaco group postoperatively within a 1-year follow-up period (Hedge’s g: 0.711 [0.315, 1.106]), but not in the FLACS group for the same period (Hedge’s g: 0.535 [-0.081, 1.151]). Conclusions: Both phaco and FLACS are good options for cataract surgeries as seen by the same CDVA and CCT outcomes. However, phacoemulsification has a greater impact on corneal endothelial cells compared to FLACS, as reflected by the endothelial cell density (ECD). Overall, this meta-analysis sheds light on the differences between phaco and FLACS with regards to FED patients.