Novel technique for hyaloid-sparing posterior capsulotomy

The authors describe a novel technique called transzonular capsulo-hyaloidal hydroseparation with optional triamcinolone enhancement. This technique can be performed to detect or induce anterior hyaloid membrane detachment for primary posterior laser capsulotomy (PPLC).

Study design

Femtolaser PPLC requires an image of both the posterior capsule and the anterior hyaloid membrane, as well as adequate space between them. A single surgeon has developed a new technique that can be performed to reliably provide the necessary image and adequate space for hyaloid-sparing posterior capsulotomy.

Outcomes

Transzonular capsulo-hyaloidal hydroseparation severs attachments that widen Berger's space, when necessary. In a stepwise fashion, dilute triamcinolone acetonide penetrates and settles on the anterior hyaloid membrane to assist OCT imaging and thereby allows for a safe posterior capsulotomy by laser.

A video clip demonstrating the surgical procedure of transzonular cortico-hyaloidal hydroseparation and traimcinolone enhancement is available at the Journal of Cataract & Refractive Surgery.

Limitations

Although no complications were observed, the impact of creating an anterior vitreous detachment is unknown.

Clinical significance

Femtolaser primary posterior capsulotomy is only feasible following standard femtosecond laser-assisted cataract surgery 75% of the time; however, this unique method allows space to perform it safely in 100% of patients. The small and portable Ziemer laser makes this technique practical. One can redock in a sterile fashion and re-enter if desired to perform optic capture to eliminate secondary cataract for patients of all ages.