Safety of femtosecond laser-assisted primary posterior capsulotomy immediately after cataract surgery.

PURPOSE: To evaluate the safety and feasibility of a new femtosecond laser-assisted method for posterior capsule opacification (PCO) prevention. SETTING: University Eye Hospital Bochum, Bochum, Germany. DESIGN: Prospective randomized intraindividual case series. METHODS: Eyes scheduled for bilateral cataract surgery between April 2015 and January 2016 were enrolled in the study. In 1 eye, routine manual cataract surgery with intraocular lens (IOL) implantation was performed with a primary posterior laser capsulotomy as the last step in the procedure. For the laser treatment, the posterior capsule between the anterior hyaloid surface and the posterior optic surface of the IOL was identified with integrated 3-dimensional spectral-domain optical coherence tomography. In the fellow eye, routine manual cataract surgery without posterior capsulotomy was performed. Follow-up examinations were done 1 week, 2 months, and 6 months after surgery. The main outcome measures were feasibility of the procedure and between-group difference in visual acuity, macular thickness, laser flare, intraocular pressure (IOP), and PCO. RESULTS: Fifty-six eyes were included. No differences in cataract density (P = .2), axial length (P = .8), or amount of ultrasound energy used (P = .55) were found between the groups. In all cases, it was possible to identify and target the posterior capsule. In 1 case, a minimal attachment of a half-hour length was seen. No significant between-group differences in visual acuity, macular thickness, laser flare, or IOP were seen. CONCLUSION: The described off-label use of primary posterior laser capsulotomy was a safe, feasible technique in preventing PCO over a 6-month follow-up.

Clinical performance in continuous curvilinear capsulorhexis creation supported by a digital image guidance system.

PURPOSE: To test whether a default capsulorhexis diameter could be attained more precisely when manual continuous curvilinear capsulorhexis (CCC) creation was supported by a biomorphological detection unit. SETTING: Ruhr University Eye Hospital, Bochum, Germany. DESIGN: Prospective interventional study. METHODS: Patients were assigned to either of 2 groups. In the first group, a digital image system was applied to guide capsulorhexis. In the second group, the CCC was created without digital support. Postoperatively, horizontal and vertical capsulorhexis dimensions were measured. A set target diameter of 5.5 mm was compared with intraoperative and postoperative CCC diameters, which were also compared with each other. The number of eyes with postoperative CCC diameters outside the reference range of 4.5 to 6.0 mm was assessed. RESULTS: In 427 eyes, the capsulorhexis size was assessed. Digital image guidance was applied in 203 eyes. Intraoperatively, horizontal capsulorhexis diameters created with surgical guidance differed significantly less from the target diameter than in the control group (P < .001). Eyes treated with surgical guidance differed significantly less from the target diameter (P < .001). Analogously, vertical capsulorhexis diameters differed significantly less from the target when digital support was used, intraoperatively and postoperatively (P < .001). In 418 eyes, postoperative diameters were significantly larger than intraoperatively in both directions (P < .001). Vertical CCC diameters were more frequently within the reference range intraoperatively and postoperatively with surgical guidance (P = .009). Horizontally, eye tracking showed accordance with the target diameter in 87.6% (controls: 91.7%). CONCLUSION: Intraoperative image guidance facilitated CCC creation significantly during standard phacoemulsification.

Primary posterior capsulotomy in femtosecond laser-assisted cataract surgery: In vivo spectral-domain optical coherence tomography study.

PURPOSE: To evaluate whether the size of Berger space is safely predictable in patients having cataract surgery using 3-dimensional spectral-domain optical coherence tomographic (3-D SD-OCT) image analysis. SETTING: Ruhr University Eye Hospital, Bochum, Germany. DESIGN: Prospective interventional case series. METHODS: Eyes having routine femtosecond laser-assisted cataract surgery were included. After wound closure, the anterior eye segment was visualized using the incorporated 3-D SD-OCT. Visualization of Berger space was performed in the axial and sagittal planes. RESULTS: The study comprised 165 consecutive eyes. In 155 eyes, 3-D SD-OCT visualized Berger space and its dimensions were analyzed. In 72% of the cases, Berger space was large enough to perform a femtosecond laser-assisted primary posterior capsulotomy. In 24 eyes (15.5%) with a minimum axial length of 25.0 mm, Berger space was 500 µm or larger. CONCLUSION: Femtosecond laser systems incorporating real-time SD-OCT allowed direct visualization of Berger space intraoperatively, providing surgeons with the information needed to safely create posterior capsulotomies after intraocular lens implantation. FINANCIAL DISCLOSURE: Dr. Dick is a consultant to Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned.