CAPSULaser - a new modality in the portfolio of cataract surgeons

Abstract

To assess the efficiency and safety of capsulorhexis with CAPSULaser in comparison with standard capsulorhexis performed manually by emerging and established surgeons. Specialized Eye Hospital-Varna Bulgaria. Prospective, randomized, non-masked study. Patients were randomized to the M group (manual CCC), L group (laser CCC), and 2 surgeons. The manual CCC was targeted at 5.5 mm. The laser CCC was sized at 5.3 mm and measured with the same caliper device during photomicroscopy. The inclusion criteria were otherwise healthy eyes with cortical, nuclear, or subcapsular cataracts of any maturity with a biomicroscopically deep anterior chamber and preoperative pupil wider than 6.5 mm. The surgical time was measured for the entire procedure and only for capsulotomy. Sixty eyes of 60 patients, aged 65.8 ± 11 years, were prospectively recruited. Two surgeons (one with 3 years and one with 30 years of experience) performed the same types and number of procedures. The experienced surgeon was 2 times faster when performing manual capsulorhexis, but the time for CAPSULaser was almost the same. The size of the "laser" CCC was planned to be 5.3 and ended up with a minimum of 5.4 in 4 weeks; however, no lens prolapse from the CCC was observed. Utilization of the CAPSULaser in cataract surgery is easy and achievable for surgeons at any stage of their careers and provides controlled, well-centered capsulorhexis with no more adverse events than conventional surgery. The limitations are the requirement for a minimal pupil size of 6 mm, a deep anterior chamber, and a transparent cornea.

Figure 1.

The most important steps of capsulotomy performed with CAPSUlaser: techniques for staining with Capsulblue® (EXCEL-LENS, Inc., Livermore, CA) (A), wash out and filling of the anterior chamber with viscoelastic(B), performing the laser for less than a second, assisting eye stabilization (C), removal of the intact capsular segment with Utrata forceps (D).

Figure 2.

The size of the capsulorhexis was performed with CAPSULaser by surgeon 1 (red) and 2 (blue), and manually in lighter green by surgeon 1 and darker green by surgeon 2 respectively. Note the big standard deviation for the manual capsulorhexis performed by the younger surgeon.