Femtosecond Laser-assisted Lens Surgery with Low-energy Pulse versus Conventional Phacoemulsification for Presbyopia Correction: An Intraindividual Study

Ramiro M. P. C. Salgado1, *, Paulo F. A. A. S. Torres2, António A. P. Marinho3
1 Departamento de Oftalmologia do Hospital da Arrábida. Hospital de Santo António, Centro Hospitalar e Universitário do Porto, Porto, Portugal
2 Departamento de Oftalmologia do Hospital da Prelada. Universidade do Porto, Porto, Portugal
3 Departamento de Oftalmologia do Hospital da Arrábida. Universidade do Porto, Porto, Portugal

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© 2021 Salgado et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Departamento de Oftalmologia do Hospital da Arrábida, Praceta Henrique Moreira 150, 4400-346 Vila Nova de Gaia, Portugal; Tel: 00351915677244; Fax: 00351224003046; E-mail:



Lens surgery with multifocal IOL implantation for presbyopia correction is performed by femtosecond laser-assisted lens surgery or conventional phacoemulsification.


To compare the clinical results of femtosecond laser-assisted with low-energy pulse conventional phacoemulsification lens surgery for presbyopia correction intraindividually.


Charts from patients who underwent Refractive Lens Exchange (RLE) for presbyopia correction in a single center, with Femtosecond Laser-Assisted Lens Surgery (FLALS) in one eye and Conventional Phacoemulsification (CP) in the other, were retrospectively reviewed. All eyes had the same multifocal Intraocular Lens (IOL) implanted. The clinical outcomes and the results of the level of satisfaction questionnaire were compared between the two groups according to the technique employed (FLALS vs. CP) for a period of up to four years. Stability, efficacy and safety indices were also assessed.


This study comprised a total of 56 eyes of 28 patients randomly assigned FLALS in one eye and CP in the other. No statistically significant difference was observed between the two techniques regarding postoperative visual acuities, duration of surgical procedure, efficacy or safety indexes (p>0.05). Refraction was stable in all FLALS eyes, whereas a change occurred in 2 eyes (7.1%) operated with CP upon 6 months postoperatively, but without statistical significance (p˃0.05). Satisfaction was slightly better with FLALS but not statistically significant (p=0.134). No immediate myosis or other adverse events after the femtosecond laser were registered.


The parameters assessed showed no significant differences between the two techniques, in spite of a difference of refraction stability upon 6 months postoperatively.

Keywords: Femtosecond, Presbyopia, Multifocal IOL, Phacoemulsification, FLACS, Intraindividual, Low-energy pulse.