Effect of Clear Corneal Incisions via Femtosecond Laser Versus Manual Incisions on Corneal Aberrations in Cataract Surgery

This study aimed to evaluate whether clear corneal incisions (CCIs) created with the FEMTO LDV Z8 femtosecond laser during cataract surgery are non-inferior to manual CCIs in terms of surgically induced astigmatism (SIA) and higher-order aberrations (HOAs). A total of 78 cataract patients were randomly assigned to two groups: 38 eyes underwent femtosecond laser-assisted cataract surgery (FLACS), and 40 eyes underwent conventional manual cataract surgery (CCS). Preoperative and six-week postoperative SIA, HOAs, and all topographic and refractive data were analysed for both groups. FLACS-generated CCIs demonstrated equivalence to manual CCIs. The mean SIA was 0.44 ± 0.27 dioptres (D) in the FLACS group and 0.58 ± 0.46 D in the CCS group (p = 0.18), with lower variability in the FLACS group. The root mean square (RMS) corneal HOA at six weeks was 0.69 ± 0.17 µm in the FLACS group and 0.80 ± 0.56 µm in the CCS group (p > 0.05). These results confirm the efficacy, reproducibility, and safety of FLACS. Although not statistically significant, FLACS induced numerically lower SIA values and less variability than manual CCIs. Both groups were comparable in terms of HOAs, though higher mean values and variability were observed in the CCS group.