Precision pulse capsulotomy as safe as manual capsulorrhexis on endothelium
Click Here to Manage Email Alerts
Key takeaways:
- Precision pulse capsulotomy is as safe on the endothelium as manually performed capsulorrhexis.
- No differences were found in endothelial cell loss and percentage of hexagonal cells.
Precision pulse capsulotomy was found in a study to be as safe as manually performed continuous curvilinear capsulorrhexis in terms of endothelial cell density and other metrics of endothelial cell condition.
Cataract surgery is normally associated with a 5% to 20% loss of endothelial cells at 1 to 3 months after surgery, mainly associated with the use of ultrasound energy. While this amount of cell loss does not cause problems for the patient, a greater loss could lead to corneal decompensation.
Image: Adobe Stock
The aim of the study was to investigate whether an automated capsulotomy technology that delivers a small amount of additional energy to the eye could potentially lead to a greater loss of endothelial cells. Other potential alterations assessed by specular microscopy were the percentage of hexagonal cells (%Hex) and the coefficient of variation (CV) of cell size among the remaining cells.
Sixty-seven patients undergoing cataract surgery were randomly assigned to the interventional precision pulse capsulotomy (PPC) group (34 patients) or the control continuous curvilinear capsulorrhexis (CCC) group (33 patients). There was no difference in mean age and mean endothelial cell density (ECD) between the two groups at baseline.
At 1 month, the mean percentage ECD loss was 11.5% in the CCC group and 12.3% in the PPC group, and at 3 months, the loss was 11.7% in the CCC group and 12.4% in the PPC group. No differences were observed in either the %Hex or the CV between the CCC and PPC groups at any of the time points analyzed.
These findings confirm that the peak of temperature increase of +2°C for a few seconds caused by the PPC in the region of the corneal endothelium has no deleterious effects on cell viability and “lend further support to the hypothesis that PPC automated capsulotomy by itself does not have any effects on [endothelial cell] condition and survival after cataract surgery,” the authors wrote.
Perspective
Back to Top
This study shows that the delicate corneal endothelial cells maintain the same healthy count regardless if the Zepto precision pulse capsulotomy (PPC) or a manual capsulorrhexis is performed. This shows that the brief millisecond pulse of energy used to create the capsular opening with Zepto does not affect the corneal endothelial cell count or cell morphology.
This gives surgeons reassurance that even in cases in which the corneal endothelium is compromised, such as in Fuchs’ dystrophy, PPC is safe and will not adversely affect these delicate cells. Multiple demonstration videos of my surgeries using the Zepto device can be found at https://cataractcoach.com/?s=zepto.
I have used the Zepto precision pulse capsulotomy extensively over the past few years in both challenging cases and routine cases. It produces a safe, precise and reliable anterior capsular opening even in tough cases such as intumescent white cataracts. With the evidence from this study, we can rest assured that this device and technique are as safe and gentle as standard manual capsulorrhexis.
Collapse
Read more about
Click Here to Manage Email Alerts