Perfecting the ideal capsulotomy

Session Details

Session Title: Femto Cataract II

Session Date/Time: Monday 15/09/2014 | 14:30-16:30

Paper Time: 15:00

Venue: Boulevard B

First Author: : M.Packer USA

Co Author(s): :                  

Abstract Details

Purpose:

To provide parameters for femtosecond laser-assisted capsulotomy, describing best practices and evidence of the importance of creation of the ideal capsulotomy for cataract removal, while limiting the risk of anterior or posterior capsule tears.

Setting:

Bowie Vision Institute, Bowie, Maryland

Methods:

The most important step in a cataract procedure is acknowledged to be creation of a perfect capsulorhexis, as it provides the framework for proper centration of the IOL and may reduce the incidence of posterior capsule opacification. Histopathological observations suggest that the creation of a continuous curvilinear capsulotomy (CCC) with a diameter slightly smaller than that of the optic of an IOL provides mechanical strength sufficient to assure the integrity of the capsule during lens extraction and to enable the capsule edge to adhere to the anterior surface of the optic, thus enhancing the efficiency of the barrier effect by creating a closed system. The ideal capsulotomy would consist of a 360 degree optic overlap, i.e. <6.0 mm. Compared to manual capsulorrhexis, creation of the capsulotomy via laser, when done correctly, can provide nearly perfect circular symmetry, with a significantly rounder and closer to intended diameter capsulotomy. This in turn will directly impact better positioning of the IOL. Histologic evidence and literature review of clinical results describing the effect of femtolaser-assisted cataract surgery and the effect on integrity of the anterior capsulotomy and effective lens placement (ELP) is presented.

Results:

When creating the capsulotomy using femtolaser assistance, selecting a diameter of ≥ 5 mm allows the capsulotomy to be placed on the stronger (thickest) part of the lens capsule. This parameter affords greater room for manipulation of surgical instruments within the capsular opening and creates a capsular edge with greater extensibility. Furthermore, the desired margin to ensure the capsular edge completely overlaps the implanted IOL is also achieved.

Conclusions:

The precision and accuracy of properly performed femtolaser-assisted anterior capsulotomy provides the foundation for safe removal of the cataract and ELP. A review of histological and clinical evidence suggests that creating a laser-assisted CCC with a diameter of approximately 5.25 mm centered on the lens apex, will maintain the integrity of the capsular bag, affording greater room for manipulation of surgical instruments within the capsular opening, while ensuring that the capsular edge completely overlaps the implanted IOL.

Financial Interest:

One or more of the authors... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, One or more of the authors... receives consulting fees, retainer, or contract payments from a competing company