Impact of anterior capsule polishing on capsule opacification and capsule bend after age-related cataract surgery

PURPOSE

To investigate the effect of anterior capsule polishing on postoperative capsule opacification and capsular bend in patients with age-related cataract displaying normal axial length.

SETTING

Eye Hospital of Wenzhou Medical University at Hangzhou.

DESIGN

Prospective self-controlled trial.

METHODS

Patients with age-related cataracts aged 56 to 84 years displaying normal axial length were enrolled. Before surgery, a coin-toss method was used to randomly select 1 eye for intraoperative 360 degrees anterior capsule polishing (polishing group); the contralateral eye received no treatment (control group). Capsular bend index (CBI), anterior capsule opacification (ACO), posterior capsule opacification (PCO), and anterior capsule opening area (ACOA) were recorded at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively using swept-source optical coherence tomography and slitlamp examination.

RESULTS

21 patients (42 eyes) were enrolled. Within-group comparisons showed that both groups had significant differences in CBI between 1 week and 1 month postoperatively, and between 6 months and 12 months postoperatively ( P < .05). Between-group comparisons revealed a significant difference in CBI at 1 week postoperatively ( P < .05); at 12 months postoperatively, there was a significant difference in ACOA ( P < .05). There were no significant between-group differences regarding ACO or PCO at any timepoint ( P > .05).

CONCLUSIONS

For patients with age-related cataracts and normal axial length, 360 degrees anterior capsule polishing can delay early capsular bag deformation without increasing the risks of ACO and PCO. This approach can also limit contraction of the anterior capsule opening.

Intraoperative trypan blue central landmark and its use in capsulotomy and capsulorhexis centration

PURPOSE

To compare 3 capsulotomy centration methods.

SETTING

Private clinic, Zlin, Czech Republic.

DESIGN

Prospective, consecutive case series.

METHODS

180 eyes undergoing cataract surgery had anterior capsule staining with microfiltered 0.4% trypan blue solution before selective laser capsulotomy. The first 60 eyes (Group 1) had mydriatic dilated pupil centered capsulotomies. The next 60 eyes (Group 2) were centered on the trypan blue central landmark (TCL). The final 60 capsulotomies (Group 3) were centered on the patient fixated coaxial Purkinje reflex (CPR). Measurements between key anatomical landmarks and the TCL, CPR capsulotomies, and implanted intraocular lens (IOL) center were made.

RESULTS

The TCL, observed in >94% of eyes in the study, coincided with the CPR with a displacement of <0.1 ± 0.1 mm. Group 1 capsulotomies were noticeably decentered on the IOLs by 0.3 ± 0.2 mm. The Group 2 symmetrical IOL relationship was maintained with a decentration of 0.15 ± 0.1 mm. Group 3 had a similar decentration with the IOLs with 0.15 ± 0.1 mm. Verification with IOLMaster 700 data and CALLISTO Eye System showed that the CPR and the TCL were coincident with the measured visual axis.

CONCLUSIONS

The clearly visible TCL served as an alternate landmark to the patient fixated CPR, and being on the anterior capsule was not sensitive to tilt. Further patient compliance was not required. Both were superior to dilated pupil centration, to achieve symmetric IOL coverage. This has application for both capsulotomies and capsulorhexes.

Severe Abnormalities of Lens Epithelial Cells in Exfoliation Syndrome: A Transmission Electron Microscopy Study of Patients with Age-Related Cataract

Background and objectives: The aim of this study was to examine via electron microscopy the lens epithelial cells in age-related cataracts and compare the findings between patients with and without exfoliation syndrome, in the Greek population. Materials and Methods: Twenty-one patients with age-related cataracts, older than 60 years, were included in the study. Eleven of them also suffered from exfoliation syndrome. Anterior lens capsules, obtained during phacoemulsification, were examined with a transmission electron microscope. Results: In all cases, ultrastructural features of diffuse intracellular and extracellular oedema were noticed to a varying degree and transparent vacuoles were detected. Often, there was more than one layer of cells, giving the impression that healthier cells tried to cover neighboring cells presenting extensive damage. Commonly, cells lost their regular shape and appeared with expanded nuclei carrying dense granules. Apoptotic cells were also detected. The epithelial cells frequently were completely destroyed or absent, exhibiting loose connections amongst them or with the basement membrane. In exfoliation syndrome (XFS) patients the alterations were more severe. Additionally, the lens epithelial cells (LECs) apical cell membrane appeared with varying distances from the basement membrane, due to different cell "heights", creating an irregular margin of the epithelium (p<0.05). Conclusion: Transmission electron microscope (TEM) examination revealed ultrastructural abnormalities in all patients' lens epithelia, more extended and more frequently observed in XFS group. In all cases, the lesions were comparable to those described in severe pathologies, all of which were excluded from the study. Environmental factors such as increased ultraviolet B (UVB) radiation exposure in Mediterranean countries, genetic factors, epigenetic factors, or all of them, could contribute to these alterations. Further epidemiological and molecular biology research is needed, so as to justify these results.

Effect of anterior capsule polish on visual function: A meta-analysis

PURPOSE

To investigate the relationship between anterior capsule polish and visual function.

METHODS

Data were obtained from Pubmed, Embase, Web of Science, WanFang, VIP and CNKI up to the end of May 2018, without any date or language restrictions for trials. The modified Jadad scale and the newcastle-ottawa scale were used to assess the quality of included studies. Uncorrected visual acuity (UCVA) and posterior capsule opacification (PCO) were used as outcome variables. Data on anterior capsule polish were pooled using weighted, random-effect meta-analysis.

RESULTS

One randomized controlled trial and 4 observational cohort studies involving 2533 patients were included in the analyses. There was a statistically significant difference of UCVA (OR 1.92, 95% CI 1.41-2.61) between the polish group and the control group, indicating that anterior capsule polish improved UCVA. Further studies with continuous data also suggested that anterior capsule polish was associated with good UCVA (MD 0.11, 95% CI 0.06-0.16). Posterior capsule opacification rate for 1-year or longer follow-up were extracted for 2561 eyes in 3 studies. Posterior capsule opacification rate was lower in the anterior capsule polish group according to summary odds ratio on PCO rate (OR 0.42 95% CI 0.24-0.73).

CONCLUSIONS

Anterior capsule polish prevents complication of modern cataract surgery and benefits on visual function in short term follow-up period.

Parameters affecting anterior capsulotomy tear strength and distension

PURPOSE

To study the effects of anterior capsulotomy diameter and discontinuity on tear threshold load and distension for the technique of continuous curvilinear capsulorhexis (CCC).

SETTING

Singapore National Eye Centre, Singapore, and CapsuLaser Inc., Livermore, California, USA.

DESIGN

Two separate randomized pairwise cadaver eye preclinical studies.

METHODS

Capsulotomies were performed in 40 cadaver eyes of 20 donors using CCC. The pairwise comparisons were divided into 2 study groups: Study A: Continuous versus discontinuous capsulotomies; Study B: Capsulotomy diameter of 5.0 mm and smaller versus diameters of 5.2 mm and larger. A shoe-tree method was used to apply load to the capsulotomy rim, and the Instron tensile stress instrument measured threshold load and distension to initiate a capsular tear. Wilcoxon matched-pairs signed-rank tests were performed to assess statistical superiority.

RESULTS

In Study Group A, all pairs demonstrated that continuous capsulotomies were better than discontinuous capsulotomies for both the anterior tear threshold load and distension (P < .01). In Study Group B, 80% of the pairs demonstrated that diameters of 5.2 mm and larger were better than those of 5.0 mm and smaller diameter (P < .05).

CONCLUSIONS

Anterior capsulotomies behave as nonlinear elastic (elastomeric) systems when exposed to an external load and distension. This study demonstrated that continuous circular capsulotomies were more resistant to anterior tears than discontinuous capsulotomies. A point of irregularity or a defect in a capsulotomy rim has a high probability of being the tear initiation point. Furthermore, larger diameter capsulotomies were more resistant to anterior tears than smaller capsulotomies.

Femtosecond Laser-Assisted Intraocular Lens Fragmentation: Low Energy Transection

PURPOSE

To describe a case of femtosecond laser-assisted hydrophobic intraocular lens transection.

METHODS

Case report.

RESULTS

Femtosecond laser-assisted transection of a one-piece acrylic hydrophobic intraocular lens for explantation via a small surgical incision was successfully performed with low energy parameters.

CONCLUSIONS

This case illustrates a novel and effective clinical application of the femtosecond laser. [J Refract Surg. 2017;33(9):646-648.].

Ideal parameters for femto-second laser-assisted anterior capsulotomy: Animal studies

In femtosecond laser-assisted cataract surgery, the parameter such as horizontal spot spacing and energy level can be adjusted. Although there have been several studies reported on various laser systems, showing the effects of varying energy levels and horizontal spot spacing on lens capsulotomy cut edges, none have been reported on the Catalys laser system (Abbott Medical Optics, Inc., Santa Ana, CA). The aim of this study is to evaluate, using scanning electron microscopy (SEM), the quality of the cut edges of the laser lens capsulotomy obtained using the Catalys Laser System, using different horizontal spot spacing and energy levels, and to determine the ideal parameters based on SEM results. Fifty rabbit capsulorhexis specimens from a femtosecond laser with different spot spacing and energy settings were divided into five groups randomly. Spot spacing was 3 um and laser pulse energy was 4 uJ in group 1. The respective values were 5 um and 2 uJ in group 2, 5 um and 4 uJ in group 3, 5 um and 6 uJ in group 4, and 7 um and 4 uJ in group 5. All samples were evaluated using SEM to compare the number of tags per capsulotomy and the laser emission time. Group 1 had a significantly lower tag formation than groups 3 and 5 (P = 0.042 and 0.021, respectively). Although the laser emission time increased about 1.5 sec as the spot spacing increased from 3 to 7 um, the quality of the cut was smoother in group 1 because of overlapping effect of photodisruption cavities. There was no significant difference between groups 2, 3 and 4 at different laser energy settings. In an ex-vivo study, samples from an energy setting of 10 uJ showed increased irregularity and damage. The degree of irregularity was higher at increasing spot spacing and laser energy settings, with abundant tag formation. Dense spot spacing with low-energy settings provide a better cut quality, which is probably correlated with the reduction in anterior capsular tear complications.

Femtosecond Laser-Assisted Capsulotomy: Histological Comparison of Four Different Laser Platforms

PURPOSE

To compare histological analyses of capsulotomies from different laser systems with regard to tissue alteration, laser spot formation, and energy settings.

METHODS

Four femtosecond laser platforms approved for cataract surgery were evaluated: LenSx (Alcon Laboratories, Inc., Fort Worth, TX), Catalys (Abbott Medical Optics, Santa Ana, CA), Victus (Tecnolas/Bausch & Lomb, Munich, Germany), and LensAR (Topcon, Gamagori, Japan). Ten human anterior lens capsulotomy disks from each laser system were analyzed: five by means of light microscopy and five by transmission electron microscopy (TEM). TEM was used especially to examine the cellular and stromal changes at the cutting edges. The cellular demarcation line was measured at 15 points along the rim and statistically compared with the findings from all laser platforms. Three capsules of each laser platform were prepared for TEM to evaluate the cellular and tissue edges of the laser cuttings.

RESULTS

All capsulotomies revealed a circular demarcation zone of different sizes along the cutting edges. Light microscopy showed a radial tissue damage of 36.0 ± 12.3 μm after Victus laser capsulotomy, 8.9 ± 2.9 μm after Catalys laser capsulotomy, 25.2 ± 5.6 μm after LensAR laser capsulotomy, and 39.8 ± 5.1 μm after LenSx laser capsulotomy. Differences between the damaged tissue zones correlated with the laser systems and their energy settings.

CONCLUSIONS

The use of less energy and larger spot separation led to smaller collateral damaged tissue areas along the cutting edges. The aberrant laser spots along the cutting edge may result in weakening of the remaining tissue, thereby enhancing the risk for capsular ruptures during surgery. [J Refract Surg. 2017;33(10):670-675.].

Laser-Assisted Capsulotomy Centration: A Prospective Trial Comparing Pupil Versus OCT-Based Scanned Capsule Centration

PURPOSE

To investigate different capsulotomy centration methods for femtosecond laser-assisted cataract surgery. The overlap between intraocular lens (IOL) optic and lens capsule was measured with different centration methods and IOL types.

METHODS

This was a prospective randomized clinical trial. Patients with cataract scheduled for femtosecond laser-assisted cataract surgery were assigned to one of four treatment groups: optical coherence tomography (OCT)-based scanned capsule centration (SCC) and three-piece IOL (SCC with three-piece IOL); scanned capsule centration and plate-haptic IOL (SCC with plate-haptic IOL); pupil centration (PC) and three-piece IOL (PC with three-piece IOL); or PC and plate-haptic IOL (PC with plate-haptic IOL). At the end of surgery, the overlap between the IOL optic and capsular bag was measured.

RESULTS

The results of 160 patients were evaluated (n = 40 in each group). There was no difference in age (P = .27), sex (P = .18), the number of treated left and right eyes (P = .64), or cataract grade (P = .06). With the new SCC method (capsulotomy diameter: 5 mm), a complete overlap was achieved in all cases in both SCC groups. The overlap was also complete in all cases with PC and plate-haptic IOLs. In the PC with three-piece IOL group, the overlap was incomplete in 3 eyes.

CONCLUSIONS

The SCC method helps to achieve a 360° overlap in all eyes independent of the IOL type. A complete 360° overlap was achieved in all cases up to a calculated capsulotomy diameter of 5.1 mm with this new method. [J Refract Surg. 2017;33(2):74-78.].

[Combined YAG-laser capsulotomy in pseudophakic patients with anterior capsular contraction syndrome]

Progressive metaplastic fibrosis of the anterior capsulorhexis opening is a frequent complication of the postoperative period. There is a widely practiced method of anterior capsular contraction syndrome (ACCS) correction through radial anterior laser capsulotomy. Despite many advantages, it can be complicated by unpredictable anterior capsule tearing and intraocular lens (IOL) dislocation into the vitreous Body, which justifies the search for new technical solutions.

AIM

to develop a safe technique of combined laser anterior capsulotomy (LAC) in patients with ACCS.

MATERIAL AND METHODS

The study included 19 patients (20 eyes) with ACCS. The suggested LAC technique involved two differently directed YAG-laser cuts that could be regarded as a combination of radial anterior capsulotomy and anterior peripheral linear capsulotomy. With the cuts located perpendicularly to each other, the distal end of each radial cut was connected to the middle of each longitudinal cut.

RESULTS

The suggested technique allows an increase in the anterior capsulorhexis diameter up to more than twice the pre-laser size. The difference between the average pre- and post-laser capsulorhexis diameters was statistically significant (р<0.0001). Neither case developed an unpredictable anterior capsule tear.

CONCLUSION

The safety of the new technique is ensured by preliminary longitudinal cuts that create a barrier against unpredictable radial tears in the capsular bag during radial capsulotomy.

Anterior Capsulotomy Outcomes: A Comparison Between Two Femtosecond Laser Cataract Surgery Platforms

PURPOSE

To compare capsulotomy outcomes between two femtosecond laser platforms for cataract surgery.

METHODS

This retrospective case series included 205 eyes of 162 consecutive patients (75 male and 87 female) aged 68.32 ± 10.27 years (range: 38 to 92 years) who underwent femtosecond laser-assisted cataract surgery (FLACS) using either the LenSx (Alcon Laboratories, Inc., Fort Worth, TX) or the Catalys (Abbott Medical Optics, Abbott Park, IL) laser platform. Intraoperative assessment of the capsulotomy was performed and graded as one of the following four types: complete treatment pattern (type 1), microadhesions (type 2), incomplete treatment pattern (type 3), and complete pattern but not continuous (type 4).

RESULTS

Ninety-seven eyes underwent FLACS using the LenSx platform and 108 eyes using the Catalys platform. Ninety-four capsulotomies in the LenSx group were graded as type 1 (96.91%), and three were graded as type 2 (3.09%); all capsulotomies in the Catalys group were graded as type 1 (100%). There was no statistically significant difference between the LenSx and Catalys groups (P > .05). No intraoperative complications (specifically, no posterior capsular extension or vitreous loss) were noticed in any of the eyes included in the study.

CONCLUSIONS

The LenSx and Catalys laser platforms demonstrate similar capsulotomy outcomes. The microadhesions that were demonstrated in three cases in the LenSx group did not lead to intraoperative or postoperative complications.

Femtosecond Laser-assisted Cataract Surgery in Patients With Marfan Syndrome and Subluxated Lens

PURPOSE

To report femtosecond laser-assisted cataract surgeries in patients with Marfan syndrome with mild, moderate, and severe lens subluxation.

METHODS

Case reports.

RESULTS

Two patients with Marfan syndrome underwent femtosecond laser-assisted cataract surgery (Alcon LenSx Lasers Inc., Aliso Viejo, CA). One patient had a mild lens subluxation in one eye and a moderate lens subluxation in the fellow eye. The other patient had a severe lens subluxation in one eye. In all eyes, the laser was able to perform a circular and free-floating anterior capsulotomy and lens fragmentation. In two of the eyes it was also helpful in decreasing corneal astigmatism by making corneal intrastromal relaxing incisions. There were no postoperative complications.

CONCLUSIONS

Femtosecond laser-assisted cataract surgery is an effective approach for cataract surgery in patients with Marfan syndrome with mild, moderate, and even severe lens subluxation, with the benefits of causing minimal further zonular damage and being able to treat corneal astigmatism with relaxing incisions.

Anterior capsule contraction treated by femtosecond laser capsulotomy

PURPOSE

To describe a new method to treat severe anterior capsule contraction using a femtosecond laser anterior capsulotomy.

METHODS

Case report.

RESULTS

A 48-year-old woman with a history of myotonic dystrophy experienced a severe contraction of the anterior capsule following an uneventful phacoemulsification cataract surgery with a hydrophilic acrylic intraocular lens implanted in the capsular bag. A femtosecond laser anterior capsulotomy was performed using a non-applanating fluid-filled interface. The spectral-domain optical coherence tomography imaging system associated with the laser enabled precise centration and location of the capsulotomy with a posterior cut located between the anterior surface of the intraocular lens and the anterior capsule inner surface. The free-floating capsulotomy was easily removed after the laser procedure, and 8 days postoperatively visual acuity recovered and myopic shift regressed with an intraocular lens centered in the capsular bag.

CONCLUSIONS

Femtosecond laser assisted by a high-resolution imaging system appears to be a safe and efficient treatment for severe anterior capsule contraction.

Prostaglandin release during femtosecond laser-assisted cataract surgery: main inducer

PURPOSE

To investigate a possible correlation between intraocular prostaglandin concentrations and partial steps of laser-assisted cataract surgery.

METHODS

Aqueous humor was collected from 67 patients after laser-assisted cataract surgery pretreatment (only capsulotomy, only fragmentation, or both) and at the beginning of routine cataract surgery. Total prostaglandin levels were measured in all four groups using an enzyme-linked immunoassay.

RESULTS

Significantly higher levels of aqueous humor prostaglandins were detected right after the full treatment (capsulotomy and fragmentation [330.6 ± 110.6 pg/mL; P = .01] or only laser capsulotomy [362.4 ± 117.5 pg/mL; P = .01]), whereas the control group showed lower values (52.5 ± 8.1 pg/mL). By itself, laser-assisted cataract surgery fragmentation did not lead to a prostaglandin increase (186.8 ± 114.0 pg/mL; P = .14).

CONCLUSIONS

This study identified the anterior capsulotomy as the main trigger for an increase of prostaglandins in the aqueous humor immediately after laser-assisted cataract surgery. Optimized energy settings in combination with nonsteroidal anti-inflammatory drugs might help reduce the phenomenon of laser-induced miosis.

Laser-assisted mini-capsulotomy: a new technique for intumescent white cataracts

PURPOSE

To describe a new two-step femtosecond laser-assisted technique for intumescent white cataracts.

METHODS

In 6 eyes with intumescent white cataracts, a laser-assisted mini-capsulotomy was performed first to release the intralenticular pressure. In the next step, the fluid milky lens material was removed from the anterior chamber before the eyes were re-docked to the laser system and a second larger anterior capsulotomy (4.5-mm diameter) was performed. Finally, the cataractous lens material was removed followed by intraocular lens implantation in the capsular bag.

RESULTS

In all cases, the laser system was able to identify and cut the anterior capsule without complications. Small residual tissue bridges were recognized after laser-assisted mini-capsulotomy in 2 eyes and solved with the dimple-down maneuver. The second, larger capsulotomy demonstrated satisfactory quality and a 360° overlap on the intraocular lens' optic was achieved in all cases.

CONCLUSIONS

This novel technique for intumescent white cataracts using a two-step laser-assisted mini-capsulotomy has the potential to avoid complications.

Efficacy of a lutein-based dye (Phacodyne™) for visualizing anterior capsulorhexis during cataract surgery by phacoemulsification

PURPOSE

To evaluate the efficacy and safety of a novel lutein-based dye for the anterior capsulorhexis during phacoemulsification in cataract surgery in humans.

METHODS

Twenty-five eyes from 25 patients were operated by 25 different surgeons who performed continuous circular capsulorhexis (CCC) guided by a lutein-based dye (Phacodyne™) during cataract surgery by phacoemulsification. A questionnaire assessed the surgeon’s opinion regarding the efficacy of the dye. Follow-up examinations were performed at 1, 7, and 30 days post-surgery. Eyes were evaluated by full ophthalmic examination, corneal topography/pachymetry, and corneal endothelial cell count.

RESULTS

As revealed by the answers to the questionnaire, the dye facilitated the CCC procedure in all eyes. Baseline nuclear cataract classification (according to the Lens Opacities Classification System III; LOCS III) was 3.24 (± 1.12). Preoperative BCVA (logMAR) was 0.89 ± 0.59 and improved to 0.23 ± 0.22 on day 30 after surgery. The intraocular pressure (IOP) remained stable and the inflammatory reaction subsided in all cases within the first 7 days after surgery. The pre-operative values of corneal pachymetry and IOP were similar to those found on follow-up day 30. Loss in endothelial cell number was similar to earlier reports.

CONCLUSION

Phacodyne™ was efficient when used for anterior capsulorhexis during cataract surgery by phacoemulsification and

The effect of femtosecond laser capsulotomy on the development of posterior capsule opacification

PURPOSE

To evaluate and compare the effects of femtosecond laser-assisted anterior capsulotomy and manual anterior capsulorhexis on posterior capsule opacification (PCO) development.

METHODS

Femtosecond laser-assisted anterior capsulotomy was performed in 40 eyes of 40 patients (FS group) and manual anterior capsulorhexis was performed in 39 eyes of 39 patients (CCC group). An AcrySof one-piece hydrophobic acrylic intraocular lens (Alcon Laboratories, Inc., Fort Worth, TX) was implanted in all eyes. The PCO level was measured using Open-Access Systematic Capsule Assessment (OSCA) software 18 to 26 months after surgery. Postoperative intraocular lens position (ie, tilt and decentration) was measured using Scheimpflug images (Pentacam; Oculus Optikgeräte GmbH, Wetzlar, Germany).

RESULTS

There was no statistically significant difference in age, axial length, and follow-up time between the two groups (P > .05). Vertical tilt, horizontal and total decentration of intraocular lenses, and PCO proved to be significantly higher in the CCC group (P = .03, .04, .03, and .01, respectively). After adjusting for axial length and follow-up time, manual anterior capsulorhexis was found to be a significant predictor of higher PCO scores in the multivariable regression model (β: 0.33; 95% CI: 0.01 to 0.65; P = .04). Vertical tilt affected PCO scores after adjusting for axial length and follow-up time (β: 0.07; 95% CI: 0.01 to 0.12; P = .02). No capsulotomies were performed during follow-up in either group.

CONCLUSIONS

Femtosecond laser-assisted anterior capsulotomy proved to be a safe procedure for postoperative PCO rates. Due to better intraocular lens position, femtosecond laser-assisted anterior capsulotomy resulted in slightly decreased PCO scores; however, evaluating its clinical significance requires further studies.

Effectiveness and safety of femtosecond laser-assisted lens fragmentation and anterior capsulotomy versus the manual technique in cataract surgery

PURPOSE

To evaluate the effectiveness and safety of cataract surgery using femtosecond laser-assisted lens fragmentation and anterior capsulotomy versus manual cataract surgery.

SETTING

MaxiVision Eye Hospital, Begumpet, Hyderabad, India.

DESIGN

Randomized controlled open-label multisurgeon prospective trial.

METHODS

Patients (at least 18 years old) were randomized to femtosecond laser-assisted lens prefragmentation and capsulotomy or manual capsulorhexis and standard phacoemulsification. Measured outcomes were effective phacoemulsification time (EPT), surgeon-assessed ease of phacoemulsification, mean phaco energy, mean phaco time, balanced salt solution volume, capsulotomy precision, and adverse event rates.

RESULTS

Fifty-six eyes had the femtosecond laser procedure, and 63 had manual cataract surgery. The mean EPT was significantly lower in the laser group (5.2 seconds ± 5.7 [SD]) than in the manual group (7.7 ± 6.0 seconds) (P=.025). There was a significant difference in the mean phaco energy between the 2 groups (13.8% ± 10.3% in laser group; 20.3% ± 8.1% in manual group) (P<.001). There were no significant between-group differences in the ease of phacoemulsification, mean phaco time, or balanced salt solution volume. Laser-assisted capsulotomies were significantly more accurate and precise (intended diameter, circularity, centration) (P<.01). The safety profiles of the procedures were equivalent, with no adverse events at the 1-day follow-up.

CONCLUSION

The femtosecond laser platform was effective and safe in cataract surgery, reducing EPT and the mean phaco energy during lens fragmentation and providing precise and reproducible capsulotomies.

Resolution of negative dysphotopsia after laser anterior capsulotomy

It has been suggested that a clear anterior nasal capsule contributes to negative dysphotopsia and that symptoms may resolve with opacification of the capsule. We describe a case in which negative dysphotopsia occurred despite a translucent anterior peripheral capsule and resolved following laser removal of the anterior nasal capsule.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

[Intraocular lens implantation into anterior capsule in the cases of posterior capsule rapture during phacoemulsification]

Rationale and safety of IOL implantation into anterior capsule in the cases of posterior capsule rapture during phacoemulsification and secondary IOL implantation into capsule duplication of aphakic eye. Degree of postoperative refractive changes is estimated.