• Written By: Lisa B. Arbisser, MD
    Cataract/Anterior Segment

    This prospective study found that the use of a femtosecond laser–assisted system for capsulotomy for intumescent white cataract appears to be safe and technically feasible, and helped avoid intraoperative capsule complications related to increased intracapsular pressure. This is believed to be the first prospective trial of this procedure in such eyes.

    This is definitely controversial, in my opinion. If we know we are going to get lens milk, I think it is still risky to use the femotosecond laser without first controlling the chamber with OVD and then docking. However, Burkhard Dick, MD, PhD, who performed the surgeries, managed it.

    Dr. Dick performed femtosecond laser-assisted capsulotomy (Catalys Precision system) in 25 eyes, followed by phacoemulsification using pulsed ultrasound energy. The lenticular capsule disk was stained intraoperatively with trypan blue and extracted using a microsurgical forceps for further analysis of form and shape.

    Optical coherence tomography detected radial anterior tears in two eyes, an adherent tongue-like capsule adhesion in nine eyes and an incomplete capsulotomy button in three eyes. In all cases, the IOL was centered and implantation was uneventful. The mean deviation from the target diameter of the extracted lenticular capsule disks was 60 μm ± 44 (SD).

    The authors note that performing a capsulotomy with a femtosecond laser in an eye with white intumescent cataract requires caution due to initial ejection of liquefied lens material into the anterior chamber once capsule breakthrough occurs.

    They conclude that the femtosecond laser offers a technical advantage and may improve the safety of surgery in high-risk cases.