Outcomes of Femtosecond Laser–Assisted Cataract Surgery in Eyes With Lens Instability

Sunday, April 19, 2015: 8:46 AM
Room 5A (San Diego Convention Center)
Joao Crispim, MD
Samantha Williamson, MD
Joshua Honghan Hou, MD
Joel Sugar, MD
Jose de la Cruz, MD, MSc
Maria S. Cortina, MD

To describe outcomes of femtosecond laser-assisted cataract surgery (FLACS) in eyes with zonular compromise.

Noncomparative retrospective case series of FLACS in all consecutive eyes with zonular or lens instability. Patient’s medical records were reviewed and demographics, presenting best-corrected visual acuity (BCVA) and postoperative BCVA, prior diagnosis and extent of zonular compromise were recorded. Operative reports were also reviewed and completion of femto assisted capsulotomy, lens fragmentation pattern used, additional surgical maneuvers required such as capsular tension ring (CTR) implantation, use of capsular hooks, etc., and femto or non femto related intraoperative complication were analyzed. Main outcome measures included successful completion of continuous capsulotomy, place of intraocular lens (IOL) implantation and centration. Secondary outcome measures included postoperative visual outcomes and intraoperative and postoperative complications.

There were 12 eyes (10 patients). Mean age was 53 ± 22 (6-79) years and mean duration of follow-up was 112 ± 78 (14-285) days. Free floating anterior capsulotomy was completed in 9 eyes (75%). In 7 cases (58.3%) one cylinder two chop pattern was used. Capsular bag was preserved in 9 cases (75%) with an aid of CTR in 5 cases (41.6%). In 3 cases, IOL could not be implanted in the bag despite the use of CTR. Preoperatively only 4 of 12 cases (33.3%) had a BCVA of 20/40 or better, as compared to 10 eyes at last visit (83.3%, P < .05, X2 test). Anterior vitrectomy occurred in 3 eyes, 1 of which occurred due to an anterior radial extension on the site of a capsular hook.

The femtosecond laser is a valuable tool that can maximize the success of a continuous capsulotomy, lens fragmentation and capsular bag preservation in cases of severe zonular compromise and anterior segment pathology.