Laser Cataract Surgery in Infants

William W. Culbertson, MD


August 23, 2013

Femtosecond Laser-Assisted Cataract Surgery in Infants

Dick HB, Schultz T
J Cataract Refract Surg. 2013;39:665-668

Challenges of Pediatric Cataract Surgery

Anterior and posterior capsulotomies are difficult steps in the performance of cataract surgery in infants and children. The anterior capsule is very elastic and tends to tear peripherally during attempted manual anterior capsulotomy. This can lead to complete loss of the capsule barrier during surgery, with loss of the capsular scaffold for future intraocular lens (IOL) placement. Virtually 100% of posterior capsules will become opacified in infants, so primary posterior capsulotomies are routinely performed during the original cataract surgery.

Femtosecond cataract lasers have the potential to create perfectly centered, round anterior and posterior capsulotomies of a specific diameter without risk for capsular tears. This article reports the successful use of the Optimedica® Catalys™ (Optimedica, Sunnyvale, California) femtosecond cataract laser in creating complete anterior and posterior capsulotomies in 4 infants undergoing cataract surgery for congenital cataracts.

Study Summary

Dick and Schultz used the Catalys cataract laser to create anterior and posterior capsulotomies in 4 infants (aged 2-9 months) with congenital cataracts. In all cases, the procedure was performed under general anesthesia with the child positioned face up on the integrated attached bed.

Initially, the surgical eye was docked to the nonapplanating liquid immersion interface, the anterior capsule was visualized with the integrated optical coherence tomography (OCT), and a central anterior capsulotomy of 3.5-4.7 mm was created using 4.0 µJ of laser energy per spot. The child was then uncoupled from the laser and rotated out under the operating microscope.

After instillation of viscoelastic, the anterior capsular cap was removed and the cataract was aspirated. The anterior chamber was filled with an ophthalmic viscosurgical device. Then the infant was swung back under the laser and the surgical eye was recoupled to the laser using the immersion patient interface.

The posterior capsule was then imaged with OCT, and the laser treatment was positioned to create a posterior capsulotomy 3.3-4.5 mm in diameter concentric to the anterior capsulotomy. Again, the eye was uncoupled from the laser and the child was swung back under the operating microscope, where the posterior capsular cap was removed.

All anterior and posterior capsulotomies were complete and uniform, without tears or tags. In 1 case, the pupil was initially too small to lase the anterior capsule, and the first step was to surgically stretch the pupil and place a Malyugin Ring® (MicroSurgical Technology; Redmond, Washington) before docking the eye for the anterior capsulotomy. In another case, the palpebral fissure was too small to allow placement of the 12.5-mm patient interface, necessitating a preliminary lateral canthotomy. This then permitted the interface to be successfully docked to the eye. In all cases, the eye was left aphakic and compensatory contact lenses were fitted. No complications were encountered.


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