Short-term choroidal changes after femtosecond laser-assisted cataract surgery and conventional phacoemulsification: a prospective observational cohort study

Comparative evidence on choroidal structural and perfusion-related changes after femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification (CPS) remains limited. This study compared longitudinal changes in subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), and choriocapillaris perfusion area (CCPA) using swept-source optical coherence tomography angiography (SS-OCTA). This single-center prospective observational cohort study included 62 eyes of 62 patients undergoing FLACS ( n = 31) or CPS ( n = 31). SS-OCTA measurements were obtained before surgery and at postoperative day 1, week 1, and month 1. Total ultrasound time (UST) and cumulative dissipated energy (CDE) were recorded intraoperatively. Longitudinal changes were analyzed using mixed-design repeated-measures analysis of variance (ANOVA), with Bonferroni adjustment for pairwise comparisons among time points within each group. The CPS group had longer UST ( P = 0.006) and higher CDE ( P < 0.001). Significant time × group interactions were observed for SFCT ( P < 0.001), CVI ( P = 0.001), and CCPA ( P = 0.001). In the FLACS group, SFCT decreased on postoperative day 1, CVI increased at postoperative day 1 and week 1, and CCPA increased at postoperative week 1 relative to baseline (all adjusted P < 0.05). None of these parameters differed significantly from baseline at postoperative month 1. In the CPS group, all three parameters remained elevated relative to baseline at all postoperative visits (all adjusted P < 0.05). FLACS and CPS were associated with distinct short-term trajectories of choroidal thickness, vascularity, and choriocapillaris perfusion-related parameters. The clinical significance of these differences warrants further investigation.