COMMENTARY

How to Make a Difficult Capsulotomy Routine

William W. Culbertson, MD

Disclosures

June 09, 2014

In This Article

Study Summary

The investigators used the CATALYS® cataract laser (Abbott Medical Optics; Abbott Park, Illinois) to perform round, 5.0 mm in diameter, anterior capsulotomies in 25 eyes with white intumescent cataracts. They evaluated the completeness of the capsulotomies and recorded the adverse events that occurred in surgery. Capsulotomy caps were evaluated histologically for completeness and for the position and pattern of laser spots.

Their findings revealed that the laser was helpful in achieving a complete round capsulotomy in 24 of 25 eyes. Capsular tags were recognized on subsequent microscopic evaluation in 11 cases; in 1 case, an incomplete cut occurred over 2 clock hours. In all cases, after careful removal of the capsulotomy cap, the residual cut edge appeared clinically to be continuous. However, peripheral radial tears occurred later during phacoemulsification in 2 cases, but it is uncertain whether this resulted from an inherent weakness in the anterior capsule in intumescent cataracts, unrelated to the laser treatment, or was somehow a result of the laser cut (a weakened edge of the capsulotomy or a microscopic discontinuity of the continuous cut). The radial tears did not extend posteriorly during surgery, and no other breaks were recognized in the anterior or posterior capsule.

Microscopic evaluation of the capsular discs showed a track of unfocused laser spots central to the edge of the cap. Presumably this resulted from elastic movement of the capsule away from the first cut edge, leaving the opposite edge of the capsule in a slightly different and more central position than the initial laser spots.

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