Incision-Site Descemet Membrane Detachment After Femtosecond Laser–Created Versus Manual Clear Corneal Incisions in Cataract Surgery: A Systematic Review
Abstract
Background: Clear corneal incision (CCI) is the standard approach in modern cataract surgery; however, incision-related Descemet membrane detachment (DMD) is increasingly recognized with the widespread use of anterior segment optical coherence tomography. Variations in incision architecture may affect posterior corneal stability and DMD risk.
Content: This systematic review compares the incidence of incision-site DMD following femtosecond laser-created versus manual CCI in adult undergoing cataract surgery. The review was conducted in accordance with PRISMA guidelines. PubMed, Cochrane Library, and ScienceDirect were searched using keywords related to femtosecond lasers, CCI, and cataract surgery. Comparative studies reporting DMD incidence intraoperatively or in the early postoperative period were included. Risk ratios were pooled using a random-effects model. Seven studies met the inclusion criteria. Across studies, femtosecond laser-created CCIs demonstrated a lower incidence of incision-site DMD than manual keratome incisions, particularly during intraoperative and early postoperative assessments using optical coherence tomography. Although not all studies reached statistical significance, the effect direction was consistent. Most DMDs were small, subclinical, and resolved spontaneously. The reduced DMD incidence associated with femtosecond laser-created incisions is biologically plausible and likely reflects improved incision geometry and posterior wound stability. Heterogeneity in study design and imaging protocols limits certainty, and the clinical relevance of subclinical DMD remains modest.
Conclusion: Femtosecond laser-created CCI are associated with a lower early risk of incision-site DMD compared with manual incisions, although most detachments are transient and clinically insignificant.
Keywords: Cataract surgery, clear corneal incision, Descemet membrane detachment, femtosecond laser, optical coherence tomography
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DOI: https://doi.org/10.37905/jmhsj.v5i2.38871
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