Comparative recovery of central corneal sensitivity after conventional phacoemulsification and femtosecond laser-assisted cataract surgery.

Objective

To compare early postoperative changes in central corneal sensitivity following conventional phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS).

Methods

This prospective two-arm cohort study included 74 patients (148 eyes) with age-related cataract who underwent either phacoemulsification (88 eyes) or FLACS (60 eyes) performed by a single surgeon between July 2024 and March 2025. Central corneal sensitivity was measured using a Cochet-Bonnet esthesiometer preoperatively and at 30 and 90 days. Outcome assessors were masked to the surgical technique. Propensity score matching and generalized estimating equations were applied to adjust for baseline differences and within-patient correlation. The primary endpoint was sensitivity at 90 days adjusted for baseline.

Results

Baseline sensitivity was slightly higher in FLACS eyes (46.08 ± 8.87 mm) compared with phacoemulsification (42.63 ± 7.18 mm, P = 0.012). At 30 days, both groups demonstrated significant reductions from baseline (P < 0.001), with no significant intergroup difference. By 90 days, sensitivity in the phacoemulsification group recovered partially but remained below baseline (40.23 ± 7.80 mm, P = 0.001), whereas sensitivity in the FLACS group returned near baseline (45.25 ± 9.13 mm, P = 0.07). Adjusted analysis favored FLACS at 90 days (mean difference: 5.02 mm; 95% CI: 2.2-7.8; P < 0.001). In the FLACS group, younger age and higher baseline sensitivity were associated with better recovery.

Conclusion

Both techniques caused early postoperative hypoesthesia, but FLACS demonstrated faster and more complete recovery of corneal sensitivity by 90 days. This neurosensory advantage may be particularly relevant for patients predisposed to ocular surface dysfunction.