Large cohort study
In this analysis, 3,842 consecutive procedures were included; in all cases the anterior capsulotomy and lens fragmentation were performed with the LenSx laser, and patients then underwent phacoemulsification and IOL insertion. Intraoperative complications were noted at the time of surgery and collated for analysis.
The main outcome measure was the intraoperative anterior capsule tear rate, Dr. Roberts said.
“It’s important to note that the curved rigid PI was used in 734 cases, and the SoftFit PI was used in the remaining 3,108 cases,” he said, adding the SoftFit software became commercially available in Australia in February 2013.
An anterior capsule tear occurred in 5 cases with the rigid curved interface (0.68%) and 2 cases with the SoftFit PI (0.08%, p = 0.004). These rates are lower than published rates for the manual techniques, he said.
“But what does clinical experience and peer-reviewed literature tell us about anterior capsule integrity after FLACS?” he said. “There is no doubt there will be ultrastructural differences if the capsulotomy is created either manually or with the laser,” Dr. Roberts said. The important question, however, is not what the ultrastructural differences are, but whether there are any relevant clinical implications?
Clinically, the laser creates a “pristine capsule edge, with better geometry and circularity compared to manual capsulorhexis,” he said. In almost all cases, the capsulotomy was free floating, he added.
“Outcomes of larger case series, such as that by the Moorfields’ group  and our study, show very lower rates of anterior capsule tears,” he said, citing rates of 0.1% or less for experienced surgeons using different laser platforms.
Advanced software and PI, combined with optimal laser settings and appropriate surgical techniques, “will result in a perfectly circular, evenly sized and intact capsulotomy in nearly every case,” he said.