COMMENTARY

Femtosecond Laser: Why We Need It for Cataract Surgery

American Academy of Ophthalmology 2013

Roger F. Steinert, MD; H. Burkhard Dick, MD, PhD

Disclosures

November 22, 2013

In This Article

Irregularities in the Anterior Capsulotomy

Dr. Steinert: You mentioned the anterior capsulotomy. A paper[1] has just come out showing irregularities of the anterior capsulotomy. Do you think that the specific maneuver that you mentioned, with having the patient hold his/her breath, is why they had irregularities in the anterior capsulotomy?

Dr. Dick: Yes, among other issues. We just sent a letter to the editor, addressing these issues. For example, the authors said that the central dimple-down technique means to go into the eye first with the cannula and dimple-down at the center of the capsulotomy so that the forces are bent inwards. I have found that, 99% of the time, the approach to the capsule is already free, but sometimes because of corneal scars or adhesions it is not free. With the central dimple-down, a force is directed inwards, and you can take it in to reduce the number of tags, for example. These are key features. We share many of these things at meetings, about how to prevent this, because if you look at the experimental trials, they have all shown that with the femtosecond treatment, there is even more resistance.

From my perspective, this is the same as with a manual capsulorrhexis. The capsulotomy is the same in terms of resistance, but it's important to change the technique accordingly. We have learned a lot from analyzing and seeing and teaching, and people need to understand this.

Dr. Steinert: So you are not seeing any evidence of weakening of the anterior capsulotomy?

Dr. Dick: No, definitely not.

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