How to Make a Difficult Capsulotomy Routine

William W. Culbertson, MD


June 09, 2014

In This Article

Femtosecond Laser-Assisted Cataract Surgery in Intumescent White Cataracts

Conrad-Hengerer I, Hengerer FH, Joachim SC, Schultz T, Dick HB
J Cataract Refract Surg. 2014;40:44-50

Capsulotomy in Intumescent White Cataracts

Performance of an anterior capsulotomy in intumescent white cataracts by traditional manual continuous curvilinear capsulotomy technique is usually difficult and occasionally hazardous. The anterior capsule of these cataracts may be more fragile than in ordinary cataracts.

More problematic is the fact that the intracapsular lens material may be swollen owing to liquefaction and hydration, and the intralenticular pressure may be elevated above intraocular pressure. Thus, as soon as an opening is made in the anterior capsule, the lens suddenly decompresses, with a rush of lens material through the capsule opening. Because the capsulotomy is not complete when this happens, a radial tear in the anterior capsule can occur, with rapid extension of the tear out to the periphery of the capsular bag. This is called the "Argentinean flag sign" (a trypan blue-stained capsule interrupted by a linear panel of white lens). In some cases, the tear wraps around the equator of the lens, resulting in a loss of the remaining lens material into the vitreous cavity.

Further complicating the successful completion of a continuous capsulotomy is the poor visualization of the capsule itself because of the lack of an adequate red reflex and the extrusion of the opaque lens material through the initial opening, which blocks the surgeon's view of the capsule.

It has been hoped that the femtosecond laser would be able to rapidly create a 360º cut in the anterior capsule, resulting in a reliable and complete circular capsulotomy without the risk for irregularity or radial extension. In this study, Conrad-Hengerer and colleagues reported their results in the use of a femtosecond laser to perform anterior capsulotomies in white intumescent cataracts.


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