Two-step femtosecond procedure helps manage capsulotomy in intumescent cataract
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VIENNA — A two-step femtosecond laser-assisted technique offers a safe way of performing capsulotomy in intumescent cataract, avoiding intraoperative complications.
“Intumescent cataract is a big challenge because you have no red reflex, you have a higher intralenticular pressure and also fluid exiting the lens, which makes the vision blurry,” Sebastian Hoffmann, MD, said at the European Society of Cataract and Refractive Surgeons meeting.
Intumescent cataract surgery has an elevated complication profile, with a high risk for anterior capsular tear and Argentinian flag sign, which can also lead to posterior capsular tear, zonulolysis, vitreous loss and IOL decentration.
The novel technique developed at the University of Bochum, Germany, entails the creation of a 2 mm diameter mini-capsulotomy with the femtosecond laser to release the intralenticular pressure. This is followed by the removal of capsule fragments with trypan blue and injection of an ophthalmic viscosurgical device (OVD) to stabilize the anterior chamber.
“Then you exchange the OVD and fluid that exited the lens with [balanced salt solution], and you can do a redocking and a second femto capsulotomy without pressure, or you can also do a normal capsulorrhexis and then proceed with the standard cataract surgery,” Hoffmann said.
The mini-capsulotomy procedure is fast, he said, with only 0.4 seconds of laser time, a total energy of 0.2 J to 0.3 J, and a pulse energy of 4 µJ.
This technique was used in 53 eyes with intumescent cataract from 2012 to May 2023. While performing the capsulotomy, an explosive discharge of lens material could be observed in all cases. The second capsulotomy was performed with the femtosecond laser in 31 eyes and manually in 22 eyes.
“If you do the second capsulotomy with the femtosecond laser, you have to redock, and it’s normally very easy and doable,” Hoffmann said.
Results were good and allowed for IOL implantation in the capsular bag in all cases. There were no cases of posterior capsule tears and no Argentinian flag sign. Anterior capsule tears occurred in two cases but were not related to the technique, Hoffmann said. One case was due to an application error during the second capsulotomy and one to head movement of the patient during phacoemulsification.
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Hoffmann S, et al. Femtosecond laser-assisted mini-capsulotomy for intumescent white cataracts. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 8-12, 2023; Vienna.
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