How to Make a Difficult Capsulotomy Routine

William W. Culbertson, MD


June 09, 2014

In This Article


The CATALYS femtosecond laser appears to facilitate the creation of round anterior capsulotomies in white intumescent lenses. When the lens capsule is under hydraulic tension, rapid elastic movement of the anterior capsule away from the first cut position allows lens material to extrude from the first cut opening. Therefore, it is imperative that the laser beam is delivered quickly and perpendicularly to the plane of the capsule to minimize asymmetric capsule cutting and uncut or irregularly cut areas of the capsulotomy.

The CATALYS laser tilts the laser cutting cylinder to cut at a right angle to the intended cutting plane rather than just elongating the cylinder. Furthermore, the ability to cut a 5.0-mm capsulotomy in less than 1.5 seconds minimizes the potential for movement of the capsulotomy during the multiple 360º passes of the laser beam through the capsule. Nevertheless, as the study authors acknowledge, there is still a greater risk for uncut areas in the capsulotomy edge, so the surgeon should be very cautious to examine for these uncut tags prior to removing the capsular cap.

A surgeon could intentionally make a smaller initial decompressing capsulotomy with the laser at perhaps 2.0-3.0 mm in diameter to shorten the cutting time to about 0.5 seconds. The extruded cloudy material could then be evacuated, followed by staining of the capsule and manually performing a larger secondary capsulotomy without the risk for sudden radial capsulotomy extension.

In summary, this study shows another way that the femtosecond laser can facilitate cataract surgery in otherwise difficult cases.


Suggested Reading

Freidman NJ, Palanker DV, Schuele G, et al. Femtosecond laser capsulotomy. J Cataract Refract Surg. 2011;37:1189-1198.

Gimbel HV, Willerscheidt AB. What to do with a limited view: the intumescent cataract. J Cataract Refract Surg. 1993;19:657-661.

Vasavada A, Singh R, Desai J. Phacoemulsification of white mature cataracts. J Cataract Refract Surg. 1998;24:270-277.


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