Minimizing Complications in Intumescent White Cataracts: Comparison of Manual and Femtosecond Laser-Assisted Capsulotomy
Narrative Responses:
Purpose
To evaluate intraoperative complications during capsulorrhexis and phacoemulsification in intumescent white cataracts using two different viscosurgical techniques for the capsulorrhexis or performing a femtosecond laser-assisted capsulotomy.
Methods
In the two manual groups after capsular staining with trypan blue in the first group (21 patients) a medium viscous OVD was used whereas in the second group (20 cases) both medium and high viscous OVD have been used to create a central indentation of the anterior lens capsule before a CCC had been performed. In the third group (21 patients) the capsulorrhexis was performed with a femtosecond lasersystem. The capsule was stained intraoperatively with trypan blue and pulled out using a microsurgical forceps. Main outcome measures were the size of the CCC and analysis of complications during surgery.
Results
In the first group deviation from target CCC diameter appeared in 12 cases compared to 6 cases in the second group. In the first group in two cases a capsular tear appeared and one case had to be converted to ECCE with anterior vitrectomy. In the second group there were no capsular tears. In the femtosecond laser-assisted group one radial anterior tear occurred and in 7 eyes an adherent tongue-like capsular adhesion; the mean deviation from the target diameter of the extracted capsule-discs valued 62 ± 41 µm. An IOL could be implanted into the capsular bag in all cases.
Conclusion
Combination of two different OVDs with high viscous OVD placed centrally lead to a safe indentation of the anterior lens capsule and reduced intraoperative complications. Femtosecond laser-assisted capsulotomy in intumescent white cataracts was superior according to size, shape and safety.