Prospective randomized evaluation of intraocular lens centration with scanned capsule vs limbus-based capsulotomy for femtosecond laser-assisted cataract surgery

Session Details

Session Title: Laser-Assisted Cataract Surgery (Femto and Other Types of Lasers)

Session Date/Time: Monday 12/09/2016 | 14:00-15:30

Paper Time: 14:18

Venue: Hall C3

First Author: : S.Basti USA

Co Author(s): :    R. Talati   R. Dalal   D. Grewal              

Abstract Details

Purpose:

The reported benefits of femtosecond cataract surgery include greater precision of the capsulotomy and better intraocular lens (IOL) and anterior capsule overlap, and hence better IOL positioning. However, to the best of our knowledge, it has not been shown whether these benefits are influenced by the method of capsulotomy centration, which can vary based on the laser platform and surgeon selection. This study sought to determine the influence of the centration method of laser capsulotomy on IOL centration and IOL-capsulotomy overlap. Additionally, changes in centration and overlap between the intraoperative period and one month following surgery were evaluated.

Setting:

This prospective, randomized study was performed by a single surgeon at a large academic center. The study was conducted in compliance with the Declaration of Helsinki and with approval from the governing institutional review board. A written informed consent was obtained prior to surgery from every patient.

Methods:

36 eyes from 22 patients undergoing femtosecond laser-assisted cataract surgery (CATALYS® Precision Laser System; Abbott Medical Optics, Illinois, USA) were assigned to either the scanned capsule (n=17) or limbus-based (n=19) method of centration. Digital retroillumination photographs were obtained intraoperatively and 1 month postoperatively. Circularity index, vector decentration, total decentration, and rim-to-optic overlap were determined using Photoshop CS6 (Adobe Systems Inc, California, USA). A benchmark value of 1.0 was used for circularity and overlap to indicate a theoretically perfect circle and perfect capsular rim-to-optic overlap, respectively.

Results:

Intraoperatively, the mean circularity index between scanned capsule (0.892 ± 0.008) and limbus-based (0.892 ± 0.004) capsulotomies was not significantly different (p=0.70). Vector decentration from the pupillary center was 0.364 ± 0.120 mm for scanned capsule compared to 0.326 ± 0.131 mm for limbus-based (p=0.46). 17/17 scanned capsule and 18/19 limbus-based capsulotomies had complete 360° rim-to-optic overlap. Scanned capsule capsulotomies were closer to a symmetrical overlap value of 1.0 than limbus-based, however this did not reach significance (p=0.06). At one month, there were no significant intergroup differences in total decentration or symmetrical overlap.

Conclusions:

Scanned capsule capsulotomies tend to achieve better overlap intraoperatively than limbus-based capsulotomies. However, scanned capsule capsulotomies undergo a decrease in vertical overlap and horizontal decentration one month following surgery, suggesting less stability and a progressive shift in capsulotomy and IOL positions. These intragroup changes are more significant in the scanned capsule eyes than limbus-based eyes (p=0.01).

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented