Lens capsule-related complications of femtosecond laser-assisted capsulotomy versus manual capsulorhexis for white cataracts

Purpose: Comparison of lens capsule-related complications resulting from femtosecond laser-assisted capsulotomy and manual capsulorhexis in patients with white cataracts. Setting: Eye Center, Second Affiliated Hospital, Zhejiang Medical School, Hangzhou, China. Design: Prospective consecutive nonrandomized comparative cohort study. Methods: Selected patients were divided into a femtosecond laser assisted cataract surgery group (FLAGS group) and a conventional phacoemulsification cataract surgery group (CPCS group). Each case was recorded as either a type I or type II white cataract. Here, type I was characterized by the presence of a liquefied cortex, whereas type II had a solid cortex. Five experienced phacoemulsification surgeons conducted all surgeries. Lens capsule-related events, including anterior capsule tears, posterior capsule ruptures (PCRs), incomplete capsulotomies, and irregular capsulorhexes were recorded; surgical parameters, postoperative visual acuities, and intra-ocular lens (IOL) decentrations were evaluated. Results: The study comprised 132 eyes of 132 patients (66 in each group). Anterior capsule tears were significantly more common in the CPCS group than the FLAGS group (12.1% versus 0%). All 8 cases of anterior capsule tears were type I cases. Six FLACS cases developed incomplete capsulotomies, four of which were type I cases. The incidences of PCRs and vitreous loss were the same. Capsulotomy produced better circularity index and diameter stability than capsulorhexis. IOLs were better centered in the FLACS group than the CPCS group. The mean ultrasound power, absolute phaco time, effective phaco time, and postoperative visual acuities were similar in both groups. Conclusions: Compared with CPCS, FLACS decreased the risk for anterior capsule tears in white cataracts, especially in type I cases. However, it did not reduce the incidence of PCR. Incomplete capsulotomy during FLAGS could happen in white cataracts. Using FLAGS on white cataracts enabled more precise capsulotomies and better-centered IOLs. (C) 2018 ASCRS and ESCRS