AIM: To systematically evaluate the effects of femtosecond laser-assisted cataract surgery and conventional ultrasound cataract surgery(CUCS)on corneal endothelial cells.

METHODS: Databases such as PubMed, Cochrane Library, Web of Science, Embase, CNKI, CBM, VIP and WanFang Data were searched for randomized controlled trials(RCT)from the establishment of the database to November 2021 on the effects of femtosecond laser cataract surgery and conventional ultrasound cataract surgery on corneal endothelial cells. Language is limited to Chinese or English. The literatures were evaluated by the Manual of Systematic Evaluation of Cochrane Interventions and the modified Jadad Scale. Stata 15.0 software was used for statistical analysis.

RESULTS: A total of 13 RCT were included, including 1 446 eyes in the FLACS group and 1 472 eyes in the CUCS group. The Meta-analysis results showed that the cumulative dissipated energy(CDE)in FLACS group was obviously lower than that in CUCS group \〖WMD=-3.84, 95%CI (-6.30, -1.38), P=0.002\〗. The effective phacoemulsification time(EPT)in the FLACS group was obviously lower than that in the CUCS group [WMD=-3.03, 95%CI(-4.00, -2.05), P<0.001]. The density of corneal endothelial cells in both the FLACS group after surgery at 1 and 3mo was higher than that in CUCS group \〖WMD=121.76, 95%CI(79.31, 164.20), P<0.001; WMD=76.04, 95%CI(19.25, 132.82), P=0.009\〗; The thickness of the central cornea in the CUCS group was significantly thicker than that in the FLACS group at 1wk after the surgery \〖WMD=-9.89, 95%CI (-18.60, -1.18), P=0.026\〗; The incidence of postoperative corneal edema in the FLACS group was less than that in the CUCS group \〖RR=0.46, 95%CI(0.32, 0.66), P<0.001]. There were no differences in the percentage of hexagonal cells and coefficient of variation of corneal endothelial cells between the two groups.

CONCLUSION: Compared with conventional ultrasound cataract surgery, femtosecond assisted cataract surgery can significantly reduce the phacoemulsification energy and the duration of the phacoemulsification energy, and significantly reduce the loss of corneal endothelial cells in the early postoperative period, while reducing the occurrence of postoperative corneal edema.