*Article* **Dry Eye Following Femtosecond Laser-Assisted Cataract Surgery: A Meta-Analysis**

**Wei-Tsun Chen 1, Yu-Yen Chen 1,2,3,4,5,6,\* and Man-Chen Hung 7**

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	- 5 School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
	- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
	- 7 Department of Medical Education, Taichung Veterans General Hospital, Taichung 407, Taiwan
	- **\*** Correspondence: yuyenchen.phd@gmail.com

**Abstract:** This study investigates the dry eye effect after femtosecond laser-assisted cataract surgery (FLACS) and also compares the risk of postoperative dry eye between FLACS and manual cataract surgery (MCS). We searched various databases between 1 January 2000 and 15 October 2022 and included peer-reviewed clinical studies in our review. Dry eye parameters were extracted at baseline and postoperative day one, week one, one month, and three months. Parameters included were the ocular surface discomfort index (OSDI), tear secretion (tear meniscus height, Schirmer's test), microscopic ocular surface damage (fluorescein staining), and tear stability (first and average tear breakup time). Additionally, the differences of each parameter at each time point were compared between FLACS and MCS. In total, six studies of 611 eyes were included. On postoperative day one, increased, pooled standardised mean differences (SMDs) were noted in the OSDI, tear secretion, tear film instability, and microscopic damage. During postoperative week one, dry eye worsened. Fortunately, dry eye achieved resolution afterwards and nearly returned to the baseline level at postoperative three months. When the parameters were compared between FLACS and MCS, those of FLACS had higher severities, but most were not statistically significant. Dry eye impact was approximately the same in FLACS and MCS at postoperative three months.

**Keywords:** dry eye; femtosecond laser-assisted cataract surgery (FLACS); phacoemulsification; cornea
