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Comparative Study
. 2018 Jan 11:2018:7242837.
doi: 10.1155/2018/7242837. eCollection 2018.

Anterior Capsule of the Lens: Comparison of Morphological Properties and Apoptosis Induction following FLACS and Standard Phacoemulsification Surgery

Alessandra Pisciotta  1   2 , Michele De Maria  1   3 , Tommaso Verdina  1 , Elisa Fornasari  1 , Anto de Pol  2 , Gian Maria Cavallini  1
Affiliations
Comparative Study

Anterior Capsule of the Lens: Comparison of Morphological Properties and Apoptosis Induction following FLACS and Standard Phacoemulsification Surgery

Alessandra Pisciotta et al. Biomed Res Int. .

Abstract

Purpose: Comparative evaluation of morphological features of anterior capsules and apoptosis induction in epithelial cells after femtosecond laser-assisted cataract surgery (FLACS) and standard phacoemulsification surgery.

Methods: Group 1: 30 FLACS anterior capsulotomies and Group 2: 30 manual anterior continuous curvilinear capsulorhexes. All patients were operated on by the same experienced surgeon. Morphological features of the anterior capsules and apoptosis induction in epithelial cells were evaluated.

Results: All patients revealed a significant mean best-corrected visual acuity (BCVA) improvement 3 months after surgery, and no major intraoperative nor postoperative complications occurred. The capsular epithelium appeared to be preserved in both groups. Scanning electron microscopy analysis revealed irregular saw-tooth shaped edges in capsules from Group 1 whereas capsules from Group 2 showed regular and smooth edges. A statistically significant higher expression of the downstream apoptotic effector cleaved caspase 3 was observed in Group 1.

Conclusions: The saw-tooth appearance was likely due to the progressive sequence of laser pulses on the capsule. The low energy/high frequency properties of the laser pulse, combined with an overlapped pulse pattern, resulted in highly continuous morphology of capsule edges. The higher apoptosis induction in FLACS group might be due to photodisruption-dependent plasma generation and formation of cavitation bubbles.

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Figures

Figure 1
Figure 1
Anterior lens capsule removal in B-MICS and FLACS surgical techniques. (a) Manual anterior capsulorhexis with micro-forceps; (b) appearance of the lens after FLACS and anterior capsulotomy removal with micro-forceps.
Figure 2
Figure 2
Histomorphology evaluation of anterior lens capsules. Phase contrast images showing edges and epithelial layer of anterior lens capsules obtained from B-MICS technique (a) and femtosecond laser assisted cataract surgery (b). Bar: 100 μm.
Figure 3
Figure 3
Histological analysis of anterior lens capsules. Cross sections of the specimens were stained with haematoxylin and eosin. On the right side, higher magnification images show details of the epithelial layer in specimens obtained following B-MICS and FLACS techniques. Bar: 10 μm.
Figure 4
Figure 4
Scanning electron microscopy analysis. Representative images of samples obtained with B-MICS (a) and (b) FLACS techniques, showing epithelial layer (left) and edges appearance (right) at different magnifications.
Figure 5
Figure 5
Evaluation of cell apoptosis in epithelial cells adherent to anterior lens capsules. (a) Immunofluorescence analysis was performed against cleaved caspase 3 (red), and nuclei were counterstained with DAPI (blue). (b) Pseudocolor images (upper) and densitometric analysis (lower) of cleaved caspase 3 in epithelial cells. Bar: 20 μm.
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