[Retrospective study on the effects of femtosecond laser-assisted cataract surgery on the cornea in diabetic patients].

Objective: This study aimed to compare the clinical outcomes of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS) in diabetic patients, and to investigate whether FLACS provides superior early postoperative visual quality recovery. Methods: A retrospective case-control study was performed. A total of 107 diabetic patients (107 eyes) who underwent cataract surgery at Chengdu Aidi Eye Hospital between May 2024 and April 2025 were enrolled. Patients were divided into the FLACS group (52 patients, 52 eyes) and the CPCS control group (55 patients, 55 eyes) according to the surgical technique. Preoperative and postoperative follow-up data within 3 months were collected. Clinical outcomes including best-corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell count, central corneal thickness (CCT), and intraoperative and postoperative complications were analyzed and compared between groups. Results: In the control group, the mean age was (70.82±8.41) years, including 25 males and 30 females. In the FLACS group, the mean age was (67.17±9.49) years, including 30 males and 22 females. No significant differences were observed in baseline characteristics such as gender, age, or lens nuclear hardness between the two groups (P>0.05). Preoperative BCVA, IOP, CCT, and corneal endothelial cell count were comparable between groups (P>0.05). At early postoperative time points (1 day and 1 week), BCVA in the FLACS group was significantly better than that in the control group: at 1 day postoperatively, the median BCVA (interquartile range) was 0.3 (0.2, 0.6) in the control group and 0.2 (0.1, 0.4) in the FLACS group; at 1 week postoperatively, it was 0.1 (0.1, 0.3) in the control group and 0.1 (0.0, 0.2) in the FLACS group (all P<0.05). At 1 month and 3 months postoperatively, no significant difference in visual acuity was detected between groups (P>0.05). Corneal endothelial cell loss was significantly lower in the FLACS group than in the control group at all postoperative follow-up time points. At 3 months, median endothelial cell loss was 434 (268, 616) cells/mm2 in the control group and 205 (74, 423) cells/mm2 in the FLACS group (P<0.05). On postoperative day 1, CCT increased to (592.29±41.79) μm in the control group and (573.71±52.24) μm in the FLACS group; the degree of corneal thickening was significantly greater in the control group (P<0.05), indicating more severe corneal edema. This difference was no longer significant from postoperative week 1 onward (P>0.05). IOP was similar between the two groups at all postoperative time points (P>0.05). The incidence of early postoperative corneal edema was significantly higher in the control group (38.2%, 21/55) than in the FLACS group (19.2%, 10/52). During the 3-month follow-up period, macular edema occurred in 2 cases in the control group, while no cases were observed in the FLACS group (P<0.05). Conclusions: For diabetic patients, FLACS significantly accelerates early postoperative visual rehabilitation and provides superior corneal protection, with less corneal endothelial cell loss and milder early postoperative corneal edema. FLACS thus demonstrates higher safety and faster recovery, and may be considered a preferred surgical option for cataract surgery in diabetic patients.