How femtosecond laser anterior capsulotomy can preserve capsular integrity in IOL exchange

Take-Home: When performing IOL exchange in eyes with anterior capsule phimosis, use of a femtosecond laser to create a secondary anterior capsulotomy can allow in-the-bag placement of the new IOL.

Reviewed by Samuel Masket, MD

Los Angeles-Findings from multiple studies demonstrate benefits of using a femtosecond laser for anterior capsulotomy during cataract surgery.

Building on that application, the femtosecond laser also provides a useful tool for creating a secondary anterior capsulotomy to assist with intraocular lens (IOL) exchange complicated by anterior capsule phimosis, said Samuel Masket, MD.

Crediting Surendra Basti, MD, Northwestern University, Chicago, for first describing the procedure, Dr. Masket has performed femtosecond laser secondary anterior capsulotomy successfully in two patients using different femtosecond laser platforms (Catalys Precision Laser System, Abbott Medical Optics; LenSx Laser System, Alcon Laboratories).

The first case, which involved a patient who was three-years, post-cataract surgery, also reinforces the importance of careful patient selection when implanting multifocal IOLs, said Dr. Masket, clinical professor, Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles.

The patient was a 75-year-old woman referred to him because of dissatisfaction with her vision after bilateral multifocal IOL implantation with a three-piece acrylic multifocal IOL. The patient had ocular surface disease, including both epithelial basement membrane dystrophy and severe dry eye disease, along with dry age-related macular degeneration. Although her binocular BCVA was only 20/50, she was expected to benefit from the IOL exchange because her potential acuity measured with a retinal acuity meter was 20/25.

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