Intumescent Cataract Research Articles

Preliminary report on the application of femtosecond laser-assisted anterior capsulotomy in intumescent white cataract surgery

Objective: To assess the effect of femtosecond laser-assisted anterior capsulotomy in intumescent white cataract surgery. Methods: Retrospective case series study. One hundred and fifty cataract patients (150 eyes) from June 2014 to June 2015 in Wuhan Aier ophthalmology hospital were enrolled in this study. They were divided into three groups: 50 intumescent white cataract patients (50 eyes) in the study group were performed femtosecond laser-assisted capsulotomy (LenSx system) operation selectively. Fifty intumescent white cataract patients (50 eyes) underwent normal manual continuous circular capsulorhexis as the control group 1. Fifty other types cataract patients (50 eyes) underwent femtosecond laser-assisted capsulotomy as the control group 2. To observe the complications such as radial tear in anterior capsule, posterior capsule rupture and vitreous prolapse occurred during operations in each group respectively. The microscopic images of the free anterior capsule after dyeing were observed in the studygroup and the control group 2. Using the German company Oculus Pentacam three-dimensional anterior eye segment system to collect the Scheimplug images of each group at 1, 3, 6 months and 1 year after operation. The data were analyzed by SPSS19.0 software package. Complications during operations in all groups were compared with Fisher exact test. The eccentricity and tilt of IOL in each group were analyzed by single factor analysis of variance. The SNK-q test was used to compare the different follow-up time groups. Results: One hundred and fifty patients aged from 50 to 86 years old, including 72 male cases and 78 female cases. In study group, radial tear in anterior capsule occurred in 2 eyes (4%), adherent tongue-like capsule adhesion was found in 6 eyes (12%), incomplete capsulotomy button happened in 2 eyes (4%), and posterior capsule rupture and vitreous prolapse occurred in 1 eye (2%). In the control group 1, radial tear in anterior capsule occurred in 8 eyes (16%) and posterior capsule rupture and vitreous prolapse occurred in 3 eyes (6%). The cases number of radial tear in anterior capsule and posterior capsule rupture and vitreous prolapse in the study group was obviously lower than the control group 1. The difference was statistically significant (P<0.05). In the control group 2, all 50 eyes were successfully completed. The implantation was uneventful and the IOL was centered. And posterior capsular rupture and vitreous prolapse did not occur. The difference was statistically significant between the study group and the control group 2 (P<0.05). After 1 year follow-up, the study group and the control group 2 showed no significant IOL tilt and eccentricity. The eccentricity and tilt of IOL in horizontal and vertical direction in control group 1 were significantly higher than those in the study group (F was 2.31, 1.10, 2.78 and 2.90 respectively) and control group 2 (F was 2.50, 2.32, 2.56 and 2.18respectively). The difference was statistically significant (P<0.05). Conclusions: Femtosecond laser-assisted anterior capsulotomy is accurate circle and center to avoid IOL eccentricity and tilt caused by capsular bag contraction asymmetrically after implantation, so as to ensure the long-term stability of the visual quality postoperatively. (Chin J Ophthalmol, 2017, 53: 281-287).

Analysis of factors of variation in lens equatorial length and axial globe length measurements using ultrasonography in dogs with cataract

Summary Purpose To evaluate biological variation of lens equatorial length (LEL) and axial globe length (AL) measurements on B-mode ultrasound and to calculate a formula to predict LEL using AL. Methods Ocular ultrasonography was performed in dogs with cataract, divided into study (n = 40) and control (n = 30) samples. LEL and AL were measured on images obtained at 10 MHz (AL, LEL10) and 35 MHz (LEL35). Breed, sex, weight, age and stage of the cataract were recorded. Dogs were categorized into groups depending on their breed. Effects of these variables on measurements were evaluated. Correlations of AL to LEL10 and LEL35 were assessed; linear regression formulas were calculated then validated. Results No significant effect of age and sex on measurements but significant effects of dogs’ group, weight and stage of the cataract were found. We found strong correlations between AL and LEL10 and between AL and LEL35. Regression formulas were LEL10 = 0.72 × AL − 1.09 and LEL35 = 0.49 × AL + 0.89. Means of the difference between measured and calculated LEL in control sample were 0.28 mm for LEL10 and −0.13 mm for LEL35. Conclusions Ocular measurements were higher in medium/large dogs than in small dogs and in intumescent and hypermature cataract than in mature. Regression formulas to predict LEL might be used with caution.

Lens decompression technique for prevention of intraoperative complications during phacoemulsification of intumescent cataract.

Purpose:To evaluate intraoperative complications during phacoemulsification of intumescent cataract using lens decompression technique.Methods:Participants with intumescent cataract scheduled for phacoemulsification were recruited and divided into two groups. In both groups, after the anterior capsule was stained with trypan blue, the anterior chamber was filled peripherally with a dispersive ophthalmic viscosurgical device (OVD) followed centrally by a higher viscosity cohesive OVD (Healon GV). In Group 2, a 25-gauge needle was then inserted into the lens center and liquid cortex aspirated by pulling back on the syringe plunger. The outcomes measured were the incidence of capsular radial tears and the incidence of conversion to extracapsular cataract extraction (ECCE).Results:In Group 1 (20 eyes), capsular radial tears occurred in four eyes, and in two eyes, the procedure had to be converted to ECCE. In Group 2 (20 eyes), no capsular radial tears or conversion to ECCE was reported.Conclusion:Lens decompression technique reduced the risk of capsular radial tears and conversion to ECCE during phacoemulsification of intumescent cataract.

Intraoperative complications in intumescent cataract surgery using a phaco capsulotomy technique

To evaluate intraoperative complications of a modified phaco capsulotomy technique and the ophthalmic viscosurgical device (OVD)-assisted capsulorhexis in eyes with intumescent white cataract. Lütfi Kırdar Kartal Eye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey. Comparative randomized case study. Eyes of patients with intumescent white cataract were divided into 2 equal groups. After the anterior capsule was stained with trypan blue, Group 1 received a modified phaco capsulotomy technique and Group 2 received a high-viscosity OVD-assisted capsulorhexis. The OVD used was sodium hyaluronate 2.0% (Protectalon 2.0%) Main outcomes were the capsulorhexis diameters, the deviations from the target diameter, and intraoperative complications. Eighty eyes of 80 patients were enrolled. There was a deviation from the target capsulorhexis diameter in 15 eyes (11 oversized, 4 undersized) in Group 1 and in 20 eyes (16 oversized, 6undersized) in Group 2. Capsule tears during capsulorhexis were observed in 2 eyes in Group 1, and the surgery was changed to extracapsular cataract extraction (ECCE) in 1 eye. In Group 2, capsule tears during capsulorhexis occurred in 22 eyes and 20 of these were managed with ECCE. The modified phaco capsulotomy technique might reduce the risk for capsule tear during capsulorhexis, leading to safe cataract surgery in cases of intumescent cataracts. None of the authors has a financial or proprietary interest in any material or method mentioned.

A Study of Profile of Patients with Cataract

Background: Cataract blindness is a public health problem of major proportions in developing countries. Intra capsular cataract extraction with aphakic spectacles has been the standard surgical technique for restoring sight. Cataracts, the world's leading cause of blindness, are an enormous public health problem in both developing and industrialized countries. Objective: To study clinical profile of patients with cataract. Methods: After applying inclusion and exclusion criteria as well as after ethical consideration only patients having cataract were included in the study. In this way, it was possible to include the 1000 patients over a period of two years. Present study was hospital based cross sectional study. A pre tested, semi structured questionnaire was used to collect the data. Complete detailed history was taken as per the questionnaire. Thorough clinical examination was carried out. The collected data was entered in Microsoft Excel Sheet and analyzed with the help of proportions. Results: The prevalence of cataract was highest in the age group of 51-60 years i.e. 45.1%. The most common prevalent type of cataract was found to be mature cataract in 50.5% of cases followed by hyper-mature cataract in 34.7% of cases. The overall incidence of capsular rupture was 4.7%. Highest incidence of capsular rupture was seen in complicated cataract followed by intumescent cataract. Incidence of vitreous loss was most commonly present in intumescent cataract followed by complicated cataract. 51% of patients recovered to normal vision of 6/6. 41.2% of patients had corrected vision from 6/60 to 6/18. Conclusion: The prevalence of cataract is common above 50 years of age. The patients reporting to the hospital for the complaint of loss vision commonly have mature or hyper-mature cataract. Complications are less in the mature and hyper-mature type of cataract.

C-Rhexis” the surgical grail in intumescent mature cataract

Background: Capsulorhexis in intumescent mature cataract has high chance of peripheral extension. This paper aims at describing a modified “C- rhexis technique”, with the unique mechanism of “simultaneously acting unidirectional vector forces” for virtually eliminating the risk of peripheral extension. Methods: Retrospective analyses of patients who were diagnosed to have intumescent mature cataract and underwent surgical intervention by a single surgeon using the modified “C-rhexis technique” were included. Results: A total of 125 eyes were included. None of the eyes experienced any capsular tag or peripheral extension of rhexis. Conclusion: In the nutshell, the “C-rhexis” virtually eliminates the risk of peripheral extension of capsulorhexis due to its unique “simultaneously acting unidirectional vector forces”. It can be easily mastered, creates an adequate size rhexis in first attempt, does not require expensive instruments and can be advocated in both MSICS and phacoemulsification. Keywords: C-rhexis1, Intumescent cataract2, Rhexis extension3, Uni-directional vector4

Surgical treatment of mature intumescent cataract

To improve phacoemulsification technique of mature intumescent cataract and to study mechanisms of possible uncontrolled tearing of the anterior lens capsule during creation of the anterior capsulorhexis. Two groups were formed. Group 1 consisted of 52 patients with mature intumescent cataract, in whom a two-stage capsulorhexis was performed with lenticular masses removed from the anterior and posterior capsular bag compartments in between the two stages. Group 2 consisted of 55 patients with mature intumescent cataract, whose capsulorhexis was standard. We have specified appropriate methods for diagnosing intumescent cataract and thoroughly investigated the mechanism of uncontrolled tearing of the anterior capsule that can occur during creation of the anterior capsulorhexis. Five structural variants of the swollen lens have been described. As to surgical complications, there were 2 cases (3.8%) of small anterior capsulorhexis tearing in group 1 that were managed by converting the capsulorhexis into the a bigger one and, thus, did not affect surgical outcomes. In group 2, there were 7 cases of uncontrolled tearing of the anterior capsule during creation of the anterior capsulorhexis, in 4 of them (7,3%) the posterior capsule got also involved. 1. It has been found that on ultrasound biomicroscopy, mature intumescent cataract is notable for a 10--15° wider equatorial angle as compared to the fellow eye, which can be regarded as spherophakia. 2. Five different structural variants of the swollen opaque lens have been described. 3. The mechanism of uncontrolled tearing of the anterior capsule during creation of the anterior capsulorhexis has been studied and the expediency of two-stage capsulorhexis with lenticular mass removal from capsular bag compartments proved.

Femtosecond laser assisted cataract surgery in intumescent cataract

Цел: Да представим ефикасността и сигурността на предна капсулотомия направена посредством фемтосекунден лазер при зряла катаракта. Методи: Приложена беше комбинирана катарактна операция като роговичните разрези и капсулорексисът бяха извършени посредством фемтосекунден лазер (LenSx, Alcon), a последващата факоемулсификация с апарат Infinity (Alcon.) Резултати: Оперирани са трима пациента (3 очи.) От тях две жени и един мъж на средна възраст 67 г. Размерът на капсулотомията бе 5,5 мм като във всички случаи беше напълно свободен без наличие на мостчета. Не се наблюдаваха радиални руптури на предната капсула или други усложнения. Заключение: Считаме, че посредством фемтосекунден лазер може да се направи сигурен, пълен на 360 o , циркулярен капсулорексис без риск за неправилност или радиално разширение при зряла катаракта.

Avoiding Complications with Femtosecond Cataract Surgery

Many potential complications in laser cataract surgery (LCS) can be avoided by careful patient selection. Patients with kyphosis, restlessness, and massive obesity might profit from other cataract surgery options. Miosis, a problem obviously caused at least in part by the femtosecond laser, can be prevented by preoperatively applying nonsteroidal anti-inflammatory drug (NSAID) eye drops. Intumescent white cataracts should receive a miniature capsulotomy first. To detect capsular tags, a modified dimple-down technique is recommended.

A prospective study of incidence and risk factors for secondary glaucoma after penetrating keratoplasty

Aim : To carry out a prospective study to analyze the incidence and risk factors for secondary glaucoma after penetrating keratoplasty (PK). Materials and Methods: Three hundred and eleven consecutive penetrating keratoplasties that were performed between January 1, 2006, and December 31, 2008, with a follow-up of 12 months were prospectively analyzed to determine the factors associated with postoperative glaucoma. Results: Of 311 eyes, secondary glaucoma developed in 57 cases. This yields an incidence of 18.3%. In conditions, such as aphakic bullous keratopathy, the incidence of post-PK glaucoma was 3.0%; in pseudophakic bullous keratopathy 14.0%, and in cases of failed graft 16.0%, while in cases of corneal ulcer and corneal opacity it was 49.0% and 18.0%, respectively. Conclusion: We conclude in our study that the incidence of glaucoma developing post-PK was highest in phakic eyes, which may be due to the formation of posterior synechiae and development of intumescent cataract. Higher incidence of glaucoma developing in infective cases could be due to recipient hot eye and the high incidence in cases of large graft could be attributed to the formation of peripheral anterior synechiae.

Traumatic endophthalmitis caused by Nocardia kruczakiae in a patient with traumatic eye injury.

BackgroundWe describe a case of traumatic ocular endophthalmitis caused by Nocardia kruczakiae after vegetable trauma in an immunocompetent child.FindingsA 5-year-old boy suffered from a trauma with a palm tree leaflet. Two months later, he was diagnosed with traumatic infectious uveitis and intumescent cataract with anterior capsule rupture. Intensive treatment with systemic and topical vancomycin, ceftazidime and methylprednisolone began. After 1 month, he underwent phacoemulsification with intraocular lens implantation (IOL).After some episodes of reactivation, he was diagnosed with traumatic nocardial endophthalmitis from aqueous humour samples. Several operations and specific antibiotic therapy resolved the infection.ConclusionsIn cases of traumatic endophthalmitis and several recurrences, it is extremely useful to make an etiologic diagnosis in order to treat the patient with specific antibiotics.

Anterior lens epithelium in intumescent white cataracts - scanning and transmission electron microscopy study.

Our purpose was to study the structure of the lens epithelial cells (LECs) of intumescent white cataracts (IC) in comparison with nuclear cataracts (NC) in order to investigate possible structural reasons for development of IC. The anterior lens capsule (aLC: basement membrane and associated LECs) were obtained from cataract surgery and prepared for scanning electron microscopy (SEM) and transmission electron microscopy (TEM). We observed by SEM that in IC, LEC swelling was pronounced with the clefts surrounding the groups of LECs. Another structural feature was spherical formations, that were observed on the apical side of LEC's, towards the fibre cell layer, both by SEM and TEM. Development of these structures, bulging out from the apical cell membrane of the LEC's and disrupting it, could be followed in steps towards the sphere formation. The degeneration of the lens epithelium and the structures of the aLC in IC similar to Morgagnian globules were also observed. None of these structural changes were observed in NC. We show by SEM and TEM that, in IC, LECs have pronounced structural features not observed in NC. This supports the hypothesis that the disturbed structure of LECs plays a role in water accumulation in the IC lens. We also suggest that, in IC, LECs produce bulging spheres that represent unique structures of degenerated material, extruded from the LEC.

Neovascular glaucoma following Nd:YAG laser capsulotomy in a patient with diabetes and syphilitic uveitis

A diabetic woman had been suffering from progressively blurry vision in the right eye for 1 year after cataract surgery. Slit lamp examination revealed bilateral band keratopathy with quiescent anterior-chamber reaction, an intumescent cataract in the left eye, and dense posterior capsular opacity in the right eye. Capsulotomy was performed, but this led to neovascular glaucoma. Because of a refractory elevation in intraocular pressure, trabeculectomy with mitomycin C treatment, vitrectomy with panretinal photocoagulation, and intravitreal injection of bevacizumab were performed. A positive rapid plasma reagin test and a positive Treponema pallidum hemagglutination assay led to the impression of syphilitic uveitis, and the patient was treated with intravenous penicillin for 2 weeks. The visual acuity of the right eye was 0.1 at the 12th-month follow up. This case shows that neovascular glaucoma may present as a complication of capsulotomy in uveitic/diabetic eyes.

Femtosecond Laser Assisted Cataract Surgery in White Cataract

Aim: To demonstrate application of femtosecond laser technology in patients with white cataract. Methods: Video-based description of successful management of intumescent white cataract with femtosecond laser technology. Results: We performed femtosecond laser assisted cataract surgery in multiple patients with different morphologies of white cataract. Successful completion of capsulotomy along with intraocular lens implantation in the bag was achieved in all the cases. No case had extension of capsulotomy upto the periphery. Conclusion: Femtosecond laser technology has revolutionized the management of difficult cataract case scenarios especially intumescent white cataract. Intraocular lens implantation in the bag with ideal capsular margin overlap can be achieved with ease in most cases.

Assessment of intraoperative complications in intumescent cataract surgery using 2 ophthalmic viscosurgical devices and trypan blue staining

To evaluate intraoperative complications during capsulorhexis and phacoemulsification in intumescent white cataracts using 2 ophthalmic viscosurgical device (OVD) techniques. Ruhr University Eye Clinic, Bochum, Germany. Case series. Patients with eyes with intumescent white cataract were recruited and placed in 2 groups. After capsule staining using trypan blue, a central indentation of the anterior lens capsule was created in the eyes in Group 1 using a medium-viscosity OVD (Healon 1.0%) and in the eyes in Group 2 using both medium-viscosity (1.0%) and high-viscosity (2.3%) OVDs. Then a continuous curvilinear capsulorhexis (CCC) was performed. The outcomes measured were the horizontal and vertical diameters of the CCC, the deviation from the target diameter, and intraoperative complications. In Group 1 (21 eyes), deviation from the target CCC diameter occurred in 12 eyes (10 oversized, 2 undersized), and in Group 2 (20 eyes) deviation occurred in 6 eyes (4 oversized, 2 undersized). In Group 1, capsule tears appeared in 2 eyes and in 1 eye, the procedure had to be converted to extracapsular cataract extraction with anterior vitrectomy. In Group 2, there were no capsule tears. Using 2 different OVDs and placing the high-viscosity OVD centrally led to safe indentation of the anterior lens capsule and reduced the risk for CCC enlargement and capsule tear during surgery. No author has a financial or proprietary interest in any material or method mentioned.

Application of posterior chamber and vitreous cloquet's canal puncture in cataract surgery

Objective To discuss the application of posterior chamber and vitreous Cloquet's canal puncture in cataract surgery. Methods Our 285 eyes of 263 nonliquefied white intumescent cataracts cases without severe diseases were randomly divided into A and B group. Puncture of posterior chamber and 0.10-0.15 ml of liquid was sucked out of the vitreous Cloquet's canal firstly before continuous circular capsulorhexis in group A. Reduced capsulorhexis diameter combined with second are capsulorhexis, capsular puncturing, pressing nucleus to discharge of liquid and reverse capsulorhexis docking was performed according to the actual situation in group B. Continuous circular capsulorhexis successful level, iris damage grade, best corrected visual acuity on postoperative day 1 and corneal edema grade were observed. Results Imperfect capsulorhexis was in 22 eyes in group A and 63 eyes in group B. Radial cracks in anterior capsules was in 3 eyes in group A and 16 eyes in group B. Tangential capsulorhexis tear was in 19 eyes in group A and 47 eyes in group B. Iris damage of more than grade 1 was in 17 eyes in group A and 51 eyes in group B. The average operation time was (9.83±2.14) minutes in group A and (10.25±3.64) minutes in group B. The best corrected visual acuity better than 0.3 on postoperative day 1 was in 122 eyes in group A and 105 eyes in group B. Corneal edema over grade I occurred in 12 eyes in group A and 39 eyes in group B. Other complications including intraoperative and postoperative hyphema and severe inflammatory after operation were in 7 eyes in group A and 18 eyes in group B. Statistical study showed significant difference (P<0.01 or P<0.05), except for operation time. In addition of 143 eyes in group A, there were 140 eyes punctured successfully in one time and 3 eyes in two times in posterior chamber and vitreous Cloquet's canal puncture. Conclusion Puncture of posterior chamber and vitreous Cloquet's canal in cataract surgery can obviously relieve anterior lens capsule tension, increase anterior chamber operation space, reduce capsulorhexis difficulty and decrease operative injury and complications by reducing the pressure from the posterior chamber and vitreous cavity. In addition, according to relative higher successful puncture rate than previous reports, we postulated that not only posterior vitreous detachment but also anterior vitreous detachment which affected the canals of petit were more commonly appeared, especially at the anterior vitreous. Meanwhile, the capacity of Cloquet's canal expanded due to the vitreous liquefaction an concentration. Moreover we suggest that age-related cortical cataract should be classified into expanded type, cured type and basic type at least in order to instruct clinical treatment. Key words: Cataract; Type, clinical; Stage, clinical; Capsulorhexis, circular, continuous

Laser-assisted mini-capsulotomy: a new technique for intumescent white cataracts.

To describe a new two-step femtosecond laser-assisted technique for intumescent white cataracts. In 6 eyes with intumescent white cataracts, a laser-assisted mini-capsulotomy was performed first to release the intralenticular pressure. In the next step, the fluid milky lens material was removed from the anterior chamber before the eyes were re-docked to the laser system and a second larger anterior capsulotomy (4.5-mm diameter) was performed. Finally, the cataractous lens material was removed followed by intraocular lens implantation in the capsular bag. In all cases, the laser system was able to identify and cut the anterior capsule without complications. Small residual tissue bridges were recognized after laser-assisted mini-capsulotomy in 2 eyes and solved with the dimple-down maneuver. The second, larger capsulotomy demonstrated satisfactory quality and a 360° overlap on the intraocular lens' optic was achieved in all cases. This novel technique for intumescent white cataracts using a two-step laser-assisted mini-capsulotomy has the potential to avoid complications.

Femtosecond Laser Assisted Keratoplasty

Aim: To demonstrate application of femtosecond laser technology in patients with white cataract. Methods: Video-based description of successful management of intumescent white cataract with femtosecond laser technology. Results: We performed femtosecond laser assisted cataract surgery in multiple patients with different morphologies of white cataract. Successful completion of capsulotomy along with intraocular lens implantation in the bag was achieved in all the cases. No case had extension of capsulotomy upto the periphery. Conclusion: Femtosecond laser technology has revolutionized the management of difficult cataract case scenarios especially intumescent white cataract. Intraocular lens implantation in the bag with ideal capsular margin overlap can be achieved with ease in most cases.

Comparison of Cataract Surgery Techniques: Safety, Efficacy, and Cost-Effectiveness

To compare the safety, efficacy, and cost-effectiveness of manual sutureless small-incision cataract surgery (SICS) and phacoemulsification (Phaco) as treatment options for cataract surgery with focus on intumescent, mature, and hypermature lenses (white cataracts). A systematic search of research articles was conducted to develop an internal database for the investigators' appraisal. Literature searches were conducted by using key words and MeSH terms including cataracts, phacoemulsification, small-incision cataract incision, visual acuity, costs, training, time, and barriers to cataract surgery. The final synthesis included 42 manuscripts. All studies show that both Phaco and SICS are safe and effective techniques to rehabilitate cataract patients, but Phaco is costlier, with its preoperative and postoperative medicines, anesthetic agents, viscoelastic materials, disposables, instrumentation, and intraocular lens (IOLs), and had a steeper learning curve. Small-incision cataract surgery, in comparison, has been shown to be faster and more cost-effective. It is useful in intumescent white, black, brown, and lens-induced glaucoma cataracts and could incorporate recent trends like topical and sub-Tenon anesthesia and temporal incisions. Both give equal best-corrected visual acuity but unaided vision has been shown to be slightly better in Phaco due to lesser astigmatism. The literature points to SICS being more useful for intumescent and hard cataracts and is the preferred technique for less-resourced settings. Small-incision cataract surgery is comparable to Phaco in almost all aspects except postoperative astigmatism.

Femtosecond laser–assisted cataract surgery in intumescent white cataracts

To evaluate the feasibility and safety of femtosecond laser-assisted capsulotomy in eyes with intumescent white cataract. Ruhr University Eye Clinic, Bochum, Germany. Prospective clinical trial. After femtosecond laser-assisted capsulotomy (Catalys Precision system), phacoemulsification was performed using pulsed ultrasound energy and the effective phacoemulsification time was evaluated. The lenticular capsule disk was stained intraoperatively with trypan blue and pulled out using a microsurgical forceps for further analysis of form and shape. Twenty-five eyes were included in this trial. Automatic optical coherence tomography detection of the anterior capsule was performed successfully in all eyes. Radial anterior tears occurred in 2 eyes, an adherent tongue-like capsule adhesion in 9 eyes, and an incomplete capsulotomy button in 3 eyes. In all cases, the intraocular lens was centered and the implantation was uneventful. The mean deviation from the target diameter of the extracted capsule disks was 60 μm ± 44 (SD). The use of the femtosecond laser-assisted system for capsulotomy in surgery for intumescent white cataract appears to be safe and technically feasible.