[Preliminary report on the application of femtosecond laser-assisted anterior capsulotomy in intumescent white cataract surgery].

Objective: To assess the effect of femtosecond laser-assisted anterior capsulotomy in intumescent white cataract surgery. Methods: Retrospective case series study. One hundred and fifty cataract patients (150 eyes) from June 2014 to June 2015 in Wuhan Aier ophthalmology hospital were enrolled in this study. They were divided into three groups: 50 intumescent white cataract patients (50 eyes) in the study group were performed femtosecond laser-assisted capsulotomy (LenSx system) operation selectively. Fifty intumescent white cataract patients (50 eyes) underwent normal manual continuous circular capsulorhexis as the control group 1. Fifty other types cataract patients (50 eyes) underwent femtosecond laser-assisted capsulotomy as the control group 2. To observe the complications such as radial tear in anterior capsule, posterior capsule rupture and vitreous prolapse occurred during operations in each group respectively. The microscopic images of the free anterior capsule after dyeing were observed in the studygroup and the control group 2. Using the German company Oculus Pentacam three-dimensional anterior eye segment system to collect the Scheimplug images of each group at 1, 3, 6 months and 1 year after operation. The data were analyzed by SPSS19.0 software package. Complications during operations in all groups were compared with Fisher exact test. The eccentricity and tilt of IOL in each group were analyzed by single factor analysis of variance. The SNK-q test was used to compare the different follow-up time groups. Results: One hundred and fifty patients aged from 50 to 86 years old, including 72 male cases and 78 female cases. In study group, radial tear in anterior capsule occurred in 2 eyes (4%), adherent tongue-like capsule adhesion was found in 6 eyes (12%), incomplete capsulotomy button happened in 2 eyes (4%), and posterior capsule rupture and vitreous prolapse occurred in 1 eye (2%). In the control group 1, radial tear in anterior capsule occurred in 8 eyes (16%) and posterior capsule rupture and vitreous prolapse occurred in 3 eyes (6%). The cases number of radial tear in anterior capsule and posterior capsule rupture and vitreous prolapse in the study group was obviously lower than the control group 1. The difference was statistically significant (P<0.05). In the control group 2, all 50 eyes were successfully completed. The implantation was uneventful and the IOL was centered. And posterior capsular rupture and vitreous prolapse did not occur. The difference was statistically significant between the study group and the control group 2 (P<0.05). After 1 year follow-up, the study group and the control group 2 showed no significant IOL tilt and eccentricity. The eccentricity and tilt of IOL in horizontal and vertical direction in control group 1 were significantly higher than those in the study group (F was 2.31, 1.10, 2.78 and 2.90 respectively) and control group 2 (F was 2.50, 2.32, 2.56 and 2.18respectively). The difference was statistically significant (P<0.05). Conclusions: Femtosecond laser-assisted anterior capsulotomy is accurate circle and center to avoid IOL eccentricity and tilt caused by capsular bag contraction asymmetrically after implantation, so as to ensure the long-term stability of the visual quality postoperatively. (Chin J Ophthalmol, 2017, 53: 281-287).

Precision pulse capsulotomy complicated by radial tear of the anterior capsule: a proposed mechanism.

Zepto precision pulsed capsulotomy is an emerging technology aimed at providing a safer and more reproducible anterior capsulorhexis, with potential advantages in challenging cases. Initial reports suggest high safety, and thus far to our knowledge, no complications have been reported. Herein we report an unexpected complication. After the pulse delivery phase on a routine cataract case, a radial tear of the anterior capsule was observed. Upon careful review of the surgery video, an air bubble was noted, at the precise clock hour of the radial tear, trapped between the device wire and capsule. This air bubble presumably prevented the transfer of rapid phase transition at this site, interfering with capsule cleavage, and resulting in incomplete capsulotomy. Based on this observation, if a trapped air bubble is observed after the vacuum phase, we recommend applying more vacuum or disengaging and reattaching, before proceeding to the pulse delivery stage.

Phacoemulsification with toric IOL implantation in Alport syndrome with anterior lenticonus having spontaneously ruptured anterior capsule.

PURPOSE: To report the outcome of phacoemulsification with toric intraocular lens (IOL) implantation in Alport syndrome with spontaneously ruptured capsule. METHODS: Case report and literature review. RESULTS: A 2.2-mm clear corneal phacoemulsification with toric lens implantation was done in anterior lenticonus with spontaneously ruptured anterior capsule. The toric IOL was well-centered with good visual outcome. CONCLUSIONS: Safe phacoemulsification with toric IOL implantation is possible in cases with spontaneous rupture of anterior lens capsule. Ability to achieve compact and complete capsulorhexis is one of the key steps to achieve favorable results.

Anterior capsular snap: new sign of zonular dehiscence and instability.

UNLABELLED: We describe the case of a 95-year-old woman with dense nuclear sclerotic cataracts and pseudoexfoliation glaucoma. Preoperative phacodonesis was noted on slitlamp biomicroscopy. During surgery, a localized anterior capsule dehiscence occurred with visible snapping of the anterior capsule over the capsulorhexis edge. This preferential anterior zonular dehiscence occurred during the lateral separation of 2 hemisegments of nucleus; the nuclear fragments protected the equatorial and posterior zonular fibers, avoiding zonular dialysis. The case was completed without incident after recognition and management of the zonular instability. The anterior capsular snap is a new sign of intraoperative anterior zonular dehiscence. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.