Scanning Electron Microscopy Analysis of the Anterior Capsulotomy Edge: A Comparative Study between Femtosecond Laser-Assisted Capsulotomy and Manual Capsulorhexis

Abstract

Purpose To compare the capsule edges ultrastructure obtained by two femtosecond laser-assisted cataract surgery (FLACS) platforms and manual continuous curvilinear capsulorhexis (CCC) using scanning electron microscopy (SEM). Setting Eye Clinic, University of Trieste, Italy. Design Experimental comparative study. Methods 150 anterior capsules were collected and divided into three groups as follows: Group 1 (50 capsules) obtained with manual CCC, Groups 2 and 3 (each with 50 capsules) obtained with the Catalys Laser and the LenSx Laser, respectively. All samples were imaged by means of SEM and regularity of the cut surface, and thickness of the capsule edge were evaluated and compared. Results All femtosecond laser (FSL) capsules were perfectly circular, whereas some alteration of the circular shape was observed in the manual ones. Group 1 showed a smooth and regular capsule edge without any surface irregularity, conversely Groups 2 and 3 showed postage-stamp perforations on the capsule edge. The cut surface irregularity value in Group 2 was 1.4 ± 0.63, while it was 0.7 ± 0.49 in Group 3 (p < 0.05). Group 1 had a significantly lower thickness of the capsule edge than the FSL groups (p < 0.05). No statistically significant difference in the capsule edge thickness between the FSL groups was found (p=0.244). Conclusions Despite the presence of slight cut surface irregularities, both FSL capsulotomies showed a better geometry and circularity than the manual ones. Capsulotomy specimens obtained using both FSL capsulotomies showed laser-induced alterations of the capsule edge when compared with smooth and regular edges obtained using manual CCC.

Argentinian flag sign during refractive laser-assisted cataract surgery – A case report

“…In comparison to other platforms, the Catalys™ Precision Laser System has been reported as a robust laser system, demonstrating superiority in complete capsulotomy when compared to the LenSx laser platform. 19 , 20 , 21 , 22 Conrad-Hengerer et al, evaluated the use of femtosecond laser–assisted capsulotomy in eyes with intumescent cataract using the Catalys™ Precision Laser System and concluded that FLACS was safe to avoid intraoperative capsule complications related to increased intracapsular pressure. 23 …”

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.…”

Clinical Results After Precision Pulse Capsulotomy

“… 8 Some studies have shown a better ability to maintain centration and circularity with femtosecond laser systems, but at the cost of a more ragged edge from the laser pulses. 9 Others have indicated that automated capsulotomy with femtosecond laser systems may be helpful in complicated cases such as white cataracts. 10 Frequent concerns related to the use of femtosecond laser systems are related to the cost of the device and the increased procedure time.…”