Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification Combined with Vitrectomy for Cataract Complicated with Fundus Disease: Superior Efficacy in Patients with Vitreous Opacity and Cost-Effectiveness Analysis

Jiasong Yang,1– 3 Zhikun Zhang,4 Hua Fan,1,5,6 Xiaolin Xie,2,3 Bo Ye,7 Yajun Wu,1,7,8 Wensheng Li1– 3 1Aier Academy of Ophthalmology, Central South University, Changsha, Hunan, People’s Republic of China; 2Shanghai Aier Eye Hospital, Aier Eye Hospital Group, Shanghai, People’s Republic of China; 3Shanghai Aier Eye Institute, Aier Eye Hospital Group, Shanghai, People’s Republic of China; 4Integrated Traditional Chinese and Western Medicine, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, People’s Republic of China; 5Aier Eye Hospital, Jinan University, Guangzhou, Guangdong, People’s Republic of China; 6Shanxi Aier Eye Hospital, Aier Eye Hospital Group, Taiyuan, Shanxi, People’s Republic of China; 7Nanchang Aier Eye Hospital, Aier Eye Hospital Group, Nanchang, Jiangxi, People’s Republic of China; 8Hunan Aier Eye Research Institute, Aier Eye Hospital Group, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Yajun Wu, Nanchang Aier Eye Hospital, Aier Eye Hospital Group, No. 68, Jiefang West Road, Xihu District, Nanchang, Jiangxi, 330002, People’s Republic of China, Email 1289638321@qq.com Wensheng Li, Aier Academy of Ophthalmology, Central South University, 435 Furong South Road, Tianxin District, Changsha, Hunan, 410015, People’s Republic of China, Email drlws@qq.comAim: To compare the efficacy of femtosecond laser assisted cataract surgery (FLACS) combined with pars plana vitrectomy (PPV) and conventional phacoemulsification surgery (CPS) combined with PPV in the treatment of cataract patients with fundus diseases.Methods: A retrospective analysis was conducted on 379 affected eyes from Shanghai Aier Eye Hospital from 01/02/2022 to 01/02/2025, divided into group A (n=182, 48%, FLACS+PPV) and group B (n=197, 52%, CPS+PPV), to compare surgical costs, best corrected visual acuity (BCVA), complications, and surgical time.Results: Postoperative visual acuity improved significantly in both groups (all P < 0.0001). For vitreous opacity (VO) patients, the BCVA improvement in group A (0.34± 0.51) was significantly better than that in group B (0.15± 0.52, P=0.03), with a shorter surgical time (45.22± 8.15 vs 52.72± 7.17 min, P < 0.0001) and lower complication rate (7.14% vs 11.68%). Overall, group A had a shorter surgical time (47.75± 10.06 vs 59.22± 11.6 min, P < 0.0001) and better postoperative BCVA (0.36± 0.45 vs 0.49± 0.48, P=0.0001) than group B, but higher surgical costs (21,600± 9180 vs 15,399± 2996 yuan, P < 0.0001).Conclusion: FLACS+PPV has excellent therapeutic effects but is expensive, while CPS+PPV has a high cost-effectiveness, and clinical selection should be based on the patient’s condition.Keywords: femtosecond laser-assisted cataract surgery, conventional phacoemulsification surgery, pars plana vitrectomy, fundus diseases, cataract