AIM:To systematically assess the efficacy and safety of femtosecond laser-assisted cataract surgery(FLACS)implanted with multifocal intraocular lens(MFIOL)with conventional cataract surgery.

METHODS: Electronic databases of PubMed, EMbase, Cochrane and OVID were searched for studies comparing FLACS-MFIOL and CP-MFIOL. Two independent reviewers performed the data extraction and analyzed. Visual acuity, spherical equivalent(SE), pseudophakic accommodation, cumulative dissipated energy(CDE)and endothelial cell density(ECD)were measured by Review Manager 5.4. Sensitivity and reporting bias were determined through the STATA 14 software.

RESULTS: From 106 screened articles, 1 045 eyes from 6 randomized controlled trials(RCTs)and 5 retrospective cohort studies were included(one of which contained two groups of comparative data). There was no evidence for any important differences in uncorrected distance visual acuity(UDVA)between FLACS-MFIOL and CP-MFIOL group after 1d, 1wk, 1, 3mo and 1a \〖s: -0.02, 95% Confidence Interval(CI)(-0.05, 0.01), P=0.13; s: -0.01, 95% CI(-0.03, 0.01), P=0.24; s: -0.03, 95% CI(-0.06, 0.00), P=0.05; s: -0.03, 95% CI(-0.14, 0.08), P=0.59; s: -0.03, 95% CI(-0.06, 0.00), P=0.10\〗. We found little evidence of any important difference in uncorrected near visual acuity(UNVA)between the two groups after 1d, 1wk, 3mo and 1a \〖s: 0.04, 95% CI(-0.04, 0.12), P=0.30; s: 0.04, 95% CI(-0.06, 0.13), P=0.47; s: 0.00, 95% CI(-0.04, 0.04), P=0.97; s: 0.03, 95% CI(-0.06, 0.12), P=0.54\〗. There was a small advantage in favor of FLACS-MFIOL over CP-MFIOL for UNVA after 1mo \〖s: 0.03, 95% CI(0.00, 0.06), P=0.04; s: 0.06, 95% CI(-0.02, 0.15), P=0.14\〗. In eyes treated with FLACS-MFIOL, SE showed no difference compared to CP-MFIOL \〖s: 0.06, 95% CI(-0.02, 0.15), P=0.14\〗, however, better than CP-MFIOL in distance and near pseudophakic accommodation \〖s: 0.57, 95% CI(0.42, 0.72), P<0.001; s: 1.32, 95% CI(0.99, 1.64), P<0.001\〗. Smaller CDE \〖s: -1.94, 95% CI(-2.59, -1.30), P<0.01; s: -3.81, 95% CI(-5.66, -1.96), P<0.01\〗 of Ⅱ and Ⅲ nucleus patients and increased ECD \〖s: 111.75, 95% CI(86.27, 137.23), P<0.01\〗 in FLACS-MFIOL group were analyzed. The sensitivity analysis indicated that the results were robust and no obvious reporting bias.

CONCLUSION: Compared to CP-MFIOL, FLACS-MFIOL makes a better visual quality and pseudophakic accommodation, as well as reducing endothelial cell loss and phacoemulsification energy.