Capsulotomy creation: Benefits with low risks

Reviewed by Timothy V. Roberts, MD

Sydney, Australia-Findings from an updated analysis of outcomes at a single center reaffirm the safety of femtosecond laser capsulotomy by showing it is associated with a low rate of anterior capsule tears.

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Cataract surgeons at the Vision Eye Institute, Sydney, Australia, began performing femtosecond laser-assisted cataract/refractive lens exchange surgery in April 2011, using one femtosecond laser system (LenSx, Alcon Laboratories). They summarized their experience in 1,500 consecutive eyes operated on between April 2011 and March 2012 and reported an anterior capsular tear rate of 0.31% [Roberts TV, et al. Ophthalmology. 2013;120(2):227-233], said Timothy V. Roberts, MD, medical director and consultant ophthalmic surgeon and senior clinical lecturer, University of Sydney.

In a follow-up report [Roberts TV, et al. J Cataract Refract Surg. 2015 May;41(5):1109-10], the surgeons reviewed data from 3,355 consecutive procedures performed between April 2012 and October 2014, and they identified 7 eyes (0.18%) with a break in the anterior capsule rim. However, among eyes operated on after the laser was upgraded with the introduction of a new, soft contact lens patient interface (SoftFit, Alcon Laboratories), the anterior capsule tear rate was just 0.08%.

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The most recent analysis included over 3,800 eyes that underwent laser anterior capsulotomy between April 2012 and September 2015, and it found that the anterior capsule tear rate remained around 1 in 1,000 cases.

“Based on initial studies, it was well accepted early on that use of the femtosecond laser compared with a manual technique enabled surgeons to more consistently achieve an accurately sized and shaped capsulotomy,” said Dr. Roberts. “Other reports, however, have raised some discussion about the quality of the laser-created capsulotomy,”

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