This article is more than 5 years old. Information may no longer be current.
Femtosecond laser capsulotomy yields less PCO than manual capsulorrhexis
IOL vertical tilt correlated with PCO in the study and control groups, but neither axial length nor follow-up time influenced the results.
Click Here to Manage Email Alerts
Femtosecond laser-assisted anterior capsulotomy resulted in less posterior capsule opacification than manual anterior capsulorrhexis, according to a study.
The laser-assisted technique also resulted in better IOL positioning than the manual method.
“The most significant finding was that the femtosecond creation of the capsulorrhexis slightly decreased the PCO rate,” Illés Kovács, MD, PhD, the corresponding author, said in an interview with Ocular Surgery News. “It seems that the femtosecond procedure is a safe procedure in terms of PCO rate.”
IOL decentration and tilt influenced PCO rates.
“[The] IOL position has a role in PCO development, and we have better IOL positioning with the femtosecond capsulorrhexis that results in lower PCO rate in the long term,” Kovács said.
The study was published in the Journal of Refractive Surgery.
The procedures
The retrospective study included 40 eyes of 40 patients who underwent femtosecond laser-assisted anterior capsulotomy. A control group comprised 39 eyes of 39 patients who underwent manual anterior capsulorrhexis.
The Lenstar LS 900 optical biometer (Haag-Streit) was used to measure axial length.
The LenSx femtosecond laser (Alcon) was used to create a 4.9-mm diameter capsulotomy in the laser group. A cystotome and forceps were used to perform manual capsulorrhexis in the manual group.
In both groups, a disposable keratome (Alcon) was used to create corneal incisions and the Infiniti Vision System (Alcon) was used to perform standard phacoemulsification.
Open-access systematic capsule assessment (OSCA) software was used to measure PCO 18 months to 26 months after surgery.
An AcrySof one-piece hydrophobic acrylic IOL (Alcon) with a 6-mm optic was inserted in the bag in all eyes, and the Pentacam Scheimpflug imaging system (Oculus) was used to measure IOL positioning, tilt and centration.
Outcomes and observations
Mean vertical tilt was 3.5° in the laser group and 5.1° in the manual group.
Mean horizontal decentration was 154.74 µm in the laser group and 260.5 µm in the manual group. Total decentration was 212.01 µm in the laser group and 320.54 µm in the manual group.
The mean OSCA score was 0.58 in the laser group and 0.84 in the manual group.
Vertical tilt, horizontal decentration, total decentration and PCO were significantly higher in the manual group than in the laser group (P = .03, P = .05, P = .03, P = .01, respectively).
Data adjusted for axial length and follow-up time showed manual anterior capsulorrhexis to be a significant predictor of higher PCO scores (P = .04).
Only vertical tilt was significantly associated with PCO levels in both groups (laser group: P < .001; manual group: P = .03).
“We found that the degree of vertical tilt has a significant effect on PCO rates, regardless of the type of capsulorrhexis, suggesting that proper IOL position has a role in protecting the posterior capsule against the proliferation of epithelial cells,” Kovács said.
He noted that the posterior capsule is better protected from PCO when the IOL is well-positioned in a central and symmetrical femtosecond laser capsulotomy.
Axial length and follow-up time did not correlate with PCO rate, Kovács said.
“In our multivariable regression model, these factors were not significant predictors for PCO development,” he said. – by Matt Hasson