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. 2023 Sep;43(9):3339-3343.
doi: 10.1007/s10792-023-02739-6. Epub 2023 May 16.

Posterior capsule dynamics during femtosecond laser lens fragmentation

Carlo Bellucci  1 , Paolo Mora  2 , Salvatore Antonio Tedesco  2 , Roberto Bellucci  3 , Stefano Gandolfi  2
Affiliations

Posterior capsule dynamics during femtosecond laser lens fragmentation

Carlo Bellucci et al. Int Ophthalmol. 2023 Sep.

Abstract

Purpose: The dynamics of the posterior capsule during femtosecond laser lens fragmentation has received little attention in the literature. We analysed the movements of the posterior capsule to identify the rupture risk factors, if any, and to suggest possible modification of the laser spot energy pattern during fragmentation.

Materials and methods: Posterior capsule ruptures during fragmentation were identified over a 10-year period of femtosecond laser use. In addition, the dynamics of the posterior capsule were identified through the real-time swept-source OCT lateral view available during the surgeries.

Results: Out of the 1465 laser cataract procedures performed, we recorded 1 case of posterior capsule rupture during lens fragmentation, which was caused by eye movement that was detected but ignored by the surgeon. Three types of posterior capsule dynamics were identified, all related to a gas bubble formation during the first part of the lens fragmentation. In eyes with a hard nucleus, the concussion of the posterior capsule was evident, however, with no capsule rupture.

Discussion: Maintaining good docking throughout the whole procedure seems important in avoiding a posterior capsule cut by the femtosecond laser. In addition, a Gaussian pattern of spot energy is suggested when fragmenting hard cataracts.

Keywords: Cataract surgery; Femtosecond laser; Posterior capsule dynamics; Posterior capsule rupture.

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Conflict of interest statement

The authors declare no competing interests.

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The eye became tilted after capsulotomy, when the fragmentation volume was already set. This resulted in posterior capsule partial cut by the femtosecond laser
Fig. 2
Fig. 2
Some movement of the posterior capsule is normal during FLACS. (Arrows indicate the posterior capsule and the microbubbles produced by the femtosecond laser.) See also Video 2 in supplementary material
Fig. 3
Fig. 3
A large gas bubble resulted in concussion of the posterior lens capsule, with transient posterior displacement especially in the central part (white arrows). See also Video 3 in supplementary material
Fig. 4
Fig. 4
The posterior capsule had sudden posterior movement at the beginning of fragmentation also changing its profile in this case (white arrow). See also Video 4 in supplementary material
See this image and copyright information in PMC

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