CAPSULOTOMY LASER

We have tried to approach the capsulotomy from a different angle,” said Pavel Stodůlka MD, PhD, of the Gemini Eye Clinics in the Czech Republic. He presented his experience with the CAPSULaser laser during an interactive free paper session on femto laser-assisted cataract surgery at the XXXIII Congress of the ESCRS in Barcelona, Spain.
“The advantages of laser capsulotomies are by now well known. They are perfectly round, and can be generated with precise diameters that can be consistently reproduced for every case,” said Dr Stodůlka.
“However, the disadvantages of femto-capsulotomy are equally widely known: the laser device is extremely costly and the entire process can be very time-consuming, as the patient often has to be moved from one operating room to another,” he added. Dr Stodůlka also pointed out the relative complexity of the whole femto-capsulotomy procedure.
The CAPSULaser is a yellow laser with continuous emission that mounts to existing operating microscopes. This eliminates the need to purchase a large unit as well as the need to transport the patient between steps.
“A high-quality capsulotomy provides the foundation for the whole surgery. What we’re all looking for is a reliable and stable effective lens position with a low incidence of posterior capsular opacity. Proper capsulotomy size and shape are crucial to achieving these goals,” he said.
Dr Stodůlka reported the results of a feasibility study of 10 eyes with standard cataract and no other intraocular pathology or previous ocular surgery. Patients were aged 68.9 ± 9.0 years. Mean axial length was 23.05 ± 1.06mm, with a mean anterior chamber depth of 3.03 ± 0.40mm. Cataract grade was approximately evenly distributed among grades 1, 2 and 3.
After corneal incisions were made and intraocular anaesthesia was administered, the capsule was stained with trypan blue for 30 seconds. The dye was then washed out by Ringer's solution, and after the anterior chamber was filled with OVD the capsulotomy took place.
The CAPSUlaser’s yellow laser interacts with the blue stained anterior lens capsule to cut a given diamtere capsulotomy. “We have used 5.0mm capsulotomy at our patient series. The laser works with various commercially available blue dyes,” explained Dr Stodůlka.
Dr Stodůlka showed delegates a video of the procedure in which a precise, free-floating capsulotomy was rapidly produced and immediately removed via a side port corneal incision using fine forceps.
“The corneal lens is designed to be disposable, but could theoretically be reusable. It provides good, convenient centration while the patient fixates on the light generated by the operating microscope,” he said.
Complete circular capsulotomy was achieved in all 10 eyes, and there were no adverse events. “The edge is as smooth as the edge of a manual capsulorhexis, and it is quite firm. I observed no tears or tags at the edge of the rhexis. Further, I didn’t encounter any problems with post-capsulotomy miosis,” he said, referring to a well-known problem seen with laser capsulotomies.
One-month results were consistent with femtosecond laser-assisted surgeries. At one month postoperatively, 80 per cent of eyes had a visual acuity of 20/20 or better. All intraocular lenses were well centred. There were no corneal epithelial or stromal issues, no postoperative flare, no iris damage, no capsular fibrosis, no increases in intraocular pressure and no fundus abnormalities.
“Three-month results confirmed stable effective lens position with no complications whatsoever, and with usual endothelial cell counts,” added Dr Stodůlka.
Dr Stodůlka was unable to discuss the technical parameters of the laser, as this information is currently still confidential. The CAPSULaser, which is being developed by a company in California’s Silicon Valley, is in the clinical validation phase.
“My first experience has been very positive, and I think this is a promising new technique. This laser is significantly less complex and less expensive compared to current femtosecond lasers, which might make laser capsulotomy more accessible for cataract surgeons worldwide than the current standards,” said Dr Stodůlka.

Pavel Stodůlka: stodulka@lasik.cz