Abstract
Background. The qualitative anterior capsulorhexis in cataract surgery in children with intraocular lens implantation is an important and crucial moment. Difficulties in carrying out capsulorhexis arise from the structural features of the lens capsule at this age. A search of new methods of the capsulorhexis formation in congenital cataract surgery with a more predictable result is an actual problem. Purpose. To study an effectiveness and a safety of the femtosecond laser in cataract surgery in children. Material and methods. The study was conducted in 29 children (30 eyes) with congenital cataracts aged from 2 to 6 years. In the group I the femtolaser capsulorhexis followed by aspiration-irrigation and IOL implantation was used in 14 children (15 eyes). In the group II, 15 children (15 eyes) underwent the manual circular continuous capsulorhexis followed by aspiration-irrigation of congenital cataract and lens implantation. The uncorrected visual acuity (UCVA) preoperatively in both (I and II) groups averaged 0.03±0.01 and 0.08±0.01, respectively. Results. In patients of the group I the femtolaser stage was unremarkable. Single subconjunctival microhemorrages were observed in 46.6% of the cases in the contact area of the vacuum ring. In 4 (26.6%) eyes after femtosecond capsulotomy a constriction of the pupil was observed. A centered anterior capsulorhexis of perfect round shape was obtained in all patients of the group I. In assessing the capsulorhexis diameter a slight increase around 100-200 microns was found intraoperatively. Single bridges that did not affect the shape, location and size of the capsulotomy were revealed during the removal of capsular flap in one case. During the manual capsulorhexis there was a tendency to runaway without going to the posterior capsule and the formation of a slightly decentered and oval capsulorhexis in patients of group II in 7 cases. Improvement of visual acuity was noted on the first day after surgery in both groups (p<0.001). The UCVA in the groups I and II on the first day after surgery was 0.3±0.04 and 0.1±0.05, respectively. Conclusions. Automated capsulorhexis with a femtosecond laser in congenital cataract surgery in children allows to exclude technical accuracy errors of this procedure and to obtain a optimal capsular fixation of the IOL, making the procedure technique more safe.
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