Efficacy of Femtosecond Laser-Assisted Capsulotomy: Experimental Evaluation Using the Zonular Dehiscence Model

Abstract

Purpose The purpose of this study was to evaluate experimentally the efficacy of femtosecond laser (FL)-assisted capsulotomy using an eye model with different degrees of zonular dehiscence (ZD). Methods An eye model with ZD was created by removing the total iris and including the planned range of the ZD in porcine and human cadaver eyes. FL-assisted capsulotomies (laser group) and manual capsulotomies (manual group) were created for the eye model with 0, 45, 135, 180, and 270 degrees of ZD. The continuity, mean diameter, ellipticity, and decentration of the capsulotomy were evaluated using the captured images. The same evaluation of FL-assisted capsulotomies was done for five human cadaver eyes with 180 degrees of ZD. Results In the laser group, no differences were seen in the mean diameter, ellipticity, and decentration, although the manual group resulted in significantly larger, ovalized, and decentered capsulotomies with different degrees of ZD ( P < 0.001, P < 0.001, and P = 0.0317, respectively). Continuous capsulotomies or capsulotomies with microadhesions were obtained up to 180 degrees of ZD, and incomplete treatment areas were seen in eyes with 270 degrees of ZD. Capsulotomy of the human cadaver eyes with 180 degrees of ZD showed similar results to those of porcine eyes. Conclusions In this experimental study, FL-assisted capsulotomy showed favorable results in eyes with between 0 and 180 degrees of ZD compared to conventional manual capsulotomy. Translational Relevance Our experimental model can simulate the capsulotomy in cases with ZD, the results are useful when determining the indication for FL-assisted capsulotomies.

Electron microscopy analysis of femtosecond laser-assisted capsulotomy before and after lens fragmentation

“…Some studies could already demonstrate analysis of femtosecond laser-assisted capsulotomy versus manual capsulorhexis 4 , 13 – 16 . Tognetto et al found a similar irregularity level with the Catalys Laser system (1.4 ± 0.63) as we did for Group 1 with the Ziemer Z8 system when performing with the capsulorhexis.…”

Recent developments in anterior capsulotomy for cataract surgery

“…A model for zonular dehiscence in human cadaver eyes and porcine eyes was used to compare FLACS capsulotomy with manual CCC. In 100 porcine eyes and 5 human eyes, the study found that for up to 180 degrees of zonular dehiscence, FLACS provided capsulotomies that were continuous or continuous with micro-adhesions, with a more consistent size and centration with different degrees of zonular dehiscence than manual CCC [42].…”

Temperature-controlled porcine eye holder for observing intraocular temperature during cataract surgery

“…Enucleated porcine eyes have been used in the ex vivo evaluation of the performance and effects of phacoemulsification and aspiration (PEA) 1,2 , femtosecond laser-assisted cataract surgery 3,4 , ophthalmic viscosurgical devices (OVDs) [5][6][7] , and implantation of intraocular lens (IOL) 8,9 . Porcine eyes are usually preserved at low temperatures, whereas balanced salt solution (BSS) and OVDs used in the ex vivo experiments are stored at lower temperatures in the surgery room or laboratory, such as 20-25 °C or 68-77 degrees Fahrenheit.…”