Objectives: To investigate the efficacy of femtosecond laser-assisted cataract surgery (FLACS) with the FEMTO LDV Z8 laser system in comparison to manual conventional cataract surgery (CCS). Background: Preservation of corneal endothelial integrity remains one of the most critical determinants of long-term visual quality after cataract surgery. The introduction of low-energy femtosecond laser systems has raised expectations for safer and more efficient procedures, particularity in cases with denser cataracts. Methods: This is a prospective, randomized study. Here, 38 eyes in the FLACS group and 40 in the CCS group were included. The changes in central corneal thickness (CCT), endothelial cell density (ECD), and best-corrected visual acuity (BCVA) were analyzed. In addition, the effective phacoemulsification time (EPT), the total phacoemulsification time (PT), and the intraoperative time (IT) were evaluated as a function of cataract grade. The total follow-up period was six weeks. Results: On postoperative day 1, BCVA improved significantly faster in the FLACS group (0.91 ± 0.14) compared with the CCS group (0.70 ± 0.17; p < 0.05). FLACS also demonstrated a significantly shorter EPT (1.01 ± 0.91 s) than CCS (1.61 ± 1.70 s; p < 0.05). No significant differences were observed between groups regarding postoperative ECD or CCT at any time point. No intraoperative or postoperative complications occurred. Conclusions: Low-energy FLACS achieved comparable endothelial safety to CCS, while providing significantly faster early visual recovery and reduced ultrasound energy use. These finding support the clinical value of FLACS in patients with moderate to dense cataracts.

Background/Objectives: The goal of this study was to show the consistency between the inflammatory and anti-inflammatory response in the early postoperative period after corneal refractive surgery (LASIK and PRK), represented by the levels of specific cytokines in the tear film. Materials/Methods: A total of 68 myopic eyes (31 in the LASIK and 37 in the PRK group) had 3 samples of tear film taken, one before surgery (t₀), another 1 h after surgery (t₁) and the third 24 h after surgery (t₂). The tear samples were then analyzed by flow cytometry in order to determine the levels of pro-inflammatory cytokines (IL-1β, IL-6, IL-8, IFN-γ, TNF-α) and the levels of anti-inflammatory cytokines (IL-4, IL-10). Results: A statistically significant positive correlation was found between the concentrations of all pro-inflammatory cytokines (IL-1β, IL-6, IL-8, IFN-γ, TNF-α) and all anti-inflammatory cytokines (IL-4, IL-10), respectively, for both t₁ and t₂ in the group of eyes that underwent LASIK. In the PRK group, there was a statistically significant positive correlation for all cytokines (pro-inflammatory and anti-inflammatory) at t₁; however at t_2, there was no correlation between IL-1β and IL-10, IL-6 and IL-10, IL-8 and IL-10, and IFN-γ and IL-10. In contrast, for other correlations between pro-inflammatory and anti-inflammatory cytokines in the same observation time (t₂), a positive correlation was observed. Conclusions: There is a consistency between the inflammatory and anti-inflammatory responses in the early postoperative period after refractive surgery, which persists longer after LASIK compared to PRK. This difference may explain the different clinical courses in patients after undergoing these procedures.

Background/Objectives: The technique used for flap creation in laser in situ keratomileusis (LASIK) may influence postoperative optical quality and visual outcomes. This prospective randomized paired-eye study compared higher-order aberrations (HOAs) and visual acuity outcomes following femtosecond laser-assisted versus mechanical microkeratome-assisted LASIK. Materials and Methods: Forty-four patients (88 eyes) underwent bilateral LASIK. In each patient, one eye was randomly assigned to high-frequency femtosecond laser flap creation (Femto LDV), and the fellow eye to mechanical microkeratome flap creation (Amadeus II). Inclusion criteria were stable refraction, central corneal thickness ≥ 520 µm, and normal corneal topography. HOAs were measured using Hartmann–Shack wavefront aberrometry over a 6 mm pupil diameter. Uncorrected and corrected distance visual acuity (UDVA and CDVA) were evaluated preoperatively and postoperatively at 1 day, 1 week, and 1, 3, and 6 months. Results: Both techniques induced significant postoperative changes in specific Zernike coefficients and an increase in total HOA root mean square (RMS) values (p < 0.05). A reduction in spherical aberration (Z4,0) was observed in both groups, while technique-specific changes were noted in individual aberration components including an increase in horizontal trefoil (Z3,3) in the femtosecond and a decrease in horizontal coma (Z5,1) in the microkeratome group. However, paired-eye comparisons revealed no statistically significant differences in total HOA six months postoperative. Despite comparable aberrometric outcomes, femtosecond-treated eyes demonstrated significantly better UDVA and CDVA at all postoperative time points (p < 0.05). Conclusions: Femtosecond laser-assisted and microkeratome-assisted LASIK resulted in comparable changes in higher-order aberrations, despite differing pattern in individual aberration components. The observed differences in visual acuity outcomes were not reflected in wavefront metrics, suggesting that postoperative visual performance may be influenced by factors.