Capsulorhexis Creation Research Articles

Optimizing the technique of anterior capsulorhexis in anterior capsule fibrosis

Purpose. To optimize the technique for femtolaser-assisted anterior capsulorhexis in patients with anterior capsular fibrosis. Material and methods. All patients were divided into two groups: group I included 12 patients with central and peripheral anterior capsule fibrosis who underwent anterior circular capsulorhexis usingfemtolaser LensX (Alcon, USA) with laser energy 10 and 15 J . Group I I included 11 patients with central and peripheral anterior capsule fibrosis, who underwent manual capsulorhexis. Results. In group II, surgical complications oc­curred in 3 cases (27.3 %), group I was uneventful. In group I, BCVA increased to 0.80 (0.70; 0.85) over the 6 months’follow-up, in group II, it increased to 0.70 (0.60; 0.70) In group I, IOP was 16.4 (15.0; 17.4) mm Hg, in group IIit was 16.2 (13.8; 18.7) mm Hg. Conclusion. Femtolaser-assisted anterior capsulorhexis in patients with anterior capsule fibrosis allowed reducing the number of operative complications by 27 % in comparison with manual capsulorhexis creation. Since even the maximum power values of the femtolaser system does not allow cutting the fibrotic capsule, we can make use of smaller power values, in particular 10 pJ, to create the anterior capsulorhexis in the area of unaffected or slightly fibrotic anterior capsule and cut the fibrotic part of the anterior capsule by collet scissors.

Формирование переднего капсулорексиса у пациентов с фиброзом передней капсулы с использованием фемтосекундного сопровождения

Purpose. To optimize the technique for the femtosecond laser-assisted anterior capsulorhexis creation in anterior capsular fibrosis. Material and methods. All patients were divided into two groups: group I included 12 patients with central and peripheral anterior capsule fibrosis who underwent anterior circular capsulorhexis creation using femtosecond laser LensX (Alcon, USA) with laser energy 10 and 15 μJ. Group II included 11 patients with central and peripheral anterior capsule fibrosis who underwent manual capsulorhexis. Results. In group II the operative complications occurred in 3 cases (27.3%), group I was uneventful. Conclusion. Femtosecond laser-assisted anterior capsulorhexis creation in patients with anterior capsule fibrosis allowed reducing the number of operative complications by 27% in comparison with manual capsulorhexis creation. It is advisable to use 10 μJ power to create the anterior capsulorhexis in the area of unaffected and slightly fibrotic anterior capsule cutting the fibrotic part of the anterior capsule by collet scissors. Key words: anterior capsolorhexis, fibrosis, anterior capsule.

Advances in capsulorhexis.

Continuous curvilinear manual capsulorhexis is currently the standard of cataract surgery. In the past several years, new technologies have been developed to improve the consistency and safety of capsulorhexis creation. This article reviews the most recent technologies in capsulotomy formation and their advantages and disadvantages. Guidance devices, femtosecond laser capsulotomy and precision pulse capsulotomy improve the centration, circularity and precision of anterior capsulorhexis and capsulotomy. These developments show particular promise for complex cataract surgeries, though clinical data on the refractive outcomes and complication rates of these technologies are currently limited and warrant additional investigation. New technological advances in capsulorhexis help surgeons achieve a more ideal capsulotomy geometry. Whether this translates into more predictable refractive outcomes and safer surgeries remains an area of future study.

Visual and Refractive Outcomes in Manual versus Femtosecond Laser–Assisted Cataract Surgery: A Single-Center Retrospective Cohort Analysis of 1838 Eyes

Femtosecond laser-assisted cataract surgery (FLACS) has emerged as an alternative to manual cataract surgery (MCS) for corneal incision and capsulorhexis creation, as well as nuclear fragmentation. This study compares postoperative refractive and visual outcomes in eyes receiving MCS or FLACS. Single-center, comparative, retrospective cohort analysis. Consecutive eyes receiving FLACS and MCS from July 1, 2012, to July 31, 2015, at a single tertiary care center. Demographic data, ocular history, preoperative measurements and biometry, and postoperative surgical results were retrospectively obtained and statistically analyzed using a generalized linear mixed model adjusting for differences in baseline characteristics and within-patient correlation. A 2-tailed P value <0.05 was considered statistically significant throughout the study. Percentage of eyes achieving absolute error (AE) ≤0.5 diopters (D). Secondary outcomes included percentage of eyes with AE ≤0.25 D and ≤1.0 D, and percentage of distance-targeted eyes achieving uncorrected distance visual acuity (UDVA) of 20/20 or better, 20/25 or better, and 20/30 or better. A total of 883 eyes received MCS and 955 received FLACS among 1089 patients. Some 82.6% of FLACS eyes and 78.8% of MCS eyes had ≤0.5 D of AE at 3 weeks, representing an adjusted odds ratio (OR) of 1.28 (95% confidence interval [CI], 0.98-1.66) of FLACS relative to MCS being within target. Some 97.1% of FLACS and 97.2% of MCS eyes had ≤1.0 D of AE (OR, 0.96; 95% CI, 0.57-1.60) and 49.3% of FLACS and 46.3% of MCS eyes, ≤0.25 D of AE (OR, 1.13; 95% CI, 0.91-1.39). Factors predictive of a favorable refractive outcome included axial length between 22 and 24.8 mm, receiving a toric intraocular lens, less preoperative cylinder, and greater preoperative average keratometry. There was no significant difference in the percentage of patients targeted for distance who achieved UDVA of 20/20 or better (P= 0.30), 20/25 or better (P= 0.06), or 20/30 or better (P= 0.66) vision. Postoperatively, there was no statistically significant difference found between eyes undergoing FLACS and eyes undergoing MCS with respect to refractive and visual outcomes.

Trypan Blue for the Assessment of Filtering Bleb Function During Cataract Surgery.

Phacoemulsification has been cited as a possible cause of bleb failure in eyes with prior trabeculectomy. No method has been developed to directly evaluate the risk of bleb failure after phacoemulsification. We investigate the use of trypan blue during cataract surgery in the setting of a preexisting trabeculectomy to evaluate the functional status of the bleb and predict postoperative bleb function. In total, 14 patients contributing 1 eye each with a history of prior trabeculectomy with mitomycin C undergoing phacoemulsification with intraocular lens implantation were enrolled in this prospective, nonrandomized clinical trial. At the time of phacoemulsification, trypan blue was instilled into the anterior chamber before capsulorhexis creation. Staining of the bleb was grouped as being mild or diffuse using intraoperative photographs. These eyes were followed for 1 year postoperatively and evaluated for intraocular pressure (IOP) control. The change in IOP was not significantly different between the 2 groups (P=0.14). A trend towards greater need for IOP-lowering medications was noted (P<0.10) in eyes with mild bleb staining. No statistically significant difference in rates of decreased bleb function was noted at 1-year follow-up after phacoemulsification. The intensity of bleb staining with trypan blue during phacoemulsification is not associated with changes in IOP postoperatively. A trend towards decreased need for IOP-lowering medications was noted in eyes with diffuse bleb staining at 1 year after cataract surgery.

Pupil dilation dynamics with an intracameral fixed combination of mydriatics and anesthetic during cataract surgery

To compare the pupil dynamics of an intracameral combination of 2 mydriatics and 1 anesthetic (Mydrane) to a standard topical regimen for cataract surgery. Sixty-two centers in Europe and 6 centers in Algeria. Prospective case series. Pupil size measurements were performed in 2 randomized studies (phase 2 and phase 3) under masked conditions (recorded videography, masked reading center). The outcomes in the phase 2 study supported evaluation of the timeframe to obtain pupil dilation and the phase 3 study provided results on mydriasis stability. Phase 2 and phase 3 comprised 139 patients and 591 patients, respectively. After intracameral combination administration, 95% of the pupil dilation was achieved within a mean of 28.6seconds±4.6 (SD). At the beginning of capsulorhexis creation, the mean pupil diameter was larger than 7.0mm in both groups. The intraoperative pupil diameter remained stable in the intracameral combination group and decreased in the topical group. The mean change in pupil size just before capsulorhexis to the end of surgery (just before cefuroxime injection) was -0.22±0.72mm and -1.67±0.98mm, respectively. No clinically significant change in pupil diameter (change <1.0mm) occurred in the majority of the intracameral combination group (89.3%) compared with the topical group (26.8%). Intracameral combination of 2 mydriatics and 1 anesthetic is an alternative to topical mydriatics for cataract surgery. The prompt onset of pupil dilation and the stable mydriasis induced by this drug combination improved the intraoperative conditions during crucial steps, such as intraocular lens implantation.

Conquering the White Cataract

We review clinical pearls in the evaluation and surgical management of white cataracts. Femtosecond laser-assisted cataract surgery is a newer technology that can aid in capsulorhexis creation, however the surgeon should be aware of the risk of incomplete capsulotomy creation in intumescent white cataracts. The surgeon should be fully prepared and anticipate challenges at every step of cataract surgery in these complex cases.

Clinical performance in continuous curvilinear capsulorhexis creation supported by a digital image guidance system

To test whether a default capsulorhexis diameter could be attained more precisely when manual continuous curvilinear capsulorhexis (CCC) creation was supported by a biomorphological detection unit. Ruhr University Eye Hospital, Bochum, Germany. Prospective interventional study. Patients were assigned to either of 2 groups. In the first group, a digital image system was applied to guide capsulorhexis. In the second group, the CCC was created without digital support. Postoperatively, horizontal and vertical capsulorhexis dimensions were measured. A set target diameter of 5.5mm was compared with intraoperative and postoperative CCC diameters, which were also compared with each other. The number of eyes with postoperative CCC diameters outside the reference range of 4.5 to 6.0mm was assessed. In 427 eyes, the capsulorhexis size was assessed. Digital imageguidance was applied in 203 eyes. Intraoperatively, horizontal capsulorhexis diameters created with surgical guidance differed significantly less from the target diameter than in the control group (P<.001). Eyes treated with surgical guidance differed significantly less from the target diameter (P<.001). Analogously, vertical capsulorhexis diameters differed significantly less from the target when digital support was used, intraoperatively and postoperatively (P<.001). In 418 eyes, postoperative diameters were significantly larger than intraoperatively in both directions (P<.001). Vertical CCC diameters were more frequently within the reference range intraoperatively and postoperatively with surgical guidance (P=.009). Horizontally, eye tracking showed accordance with the target diameter in 87.6% (controls: 91.7%). Intraoperative image guidance facilitated CCC creation significantly during standard phacoemulsification.

Simple approach to prevent capsule tear-out during capsulorhexis creation in hypermature cataracts

Capsule tear-out in hypermature cataracts (Argentinean flag sign) is a common and frustrating complication during the creation of a capsulorhexis. Completing the capsulorhexis through a small side-port incision, filling the anterior chamber with a highly viscous ophthalmic viscosurgical device such as a viscoadaptive agent, and using a 23- or 25-gauge microcapsulorhexis forceps to fill the side-port incision can reliably prevent this complication. Neither author has a financial or proprietary interest in any material or method mentioned.

Clinical characteristics and surgical outcomes of phacoemulsification in true exfoliation syndrome

To review the clinical characteristics and surgical outcomes of patients with true exfoliation syndrome of the lens capsule having phacoemulsification cataract surgery. Hong Kong Eye Hospital, Kowloon, Hong Kong. Case series. Eyes of patients with true exfoliation syndrome diagnosed clinically or intraoperatively had standard phacoemulsification and intraocular lens (IOL) implantation. The anterior capsules removed during capsulorhexis were sent for histological confirmation. Twenty-four eyes of 18 patients were included. All eyes were confirmed to have true exfoliation syndrome by histological examination of the anterior lens capsule. Seven eyes (29.2%) had preexisting chronic glaucoma; 5 (20.8%) had laser iridotomy before the diagnosis. During phacoemulsification, all eyes had a continuous curvilinear capsulorhexis without complications. Trypan blue staining was used during capsulorhexis in 11 eyes (45.8%). Posterior capsule rupture occurred during lens chopping in 1 eye (4.2%). No loose zonular fibers or radial extension of capsulorhexis occurred. Capsular bag IOL implantation was successfully performed in all cases except the 1 with a posterior capsule rupture, in which an anterior chamber IOL was implanted. Phacoemulsification was safely performed in eyes with true exfoliation syndrome. Trypan blue staining can be used to facilitate capsulorhexis creation. Ultrasound biomicroscopy or anterior segment optical coherence tomography may be useful in preoperative assessment of such cases. The disease may be associated with glaucoma and laser iridotomy.