Precision pulse capsulotomy

Effective and quick automated capsulotomy device offers advantages over femtolaser

Dermot McGrath

Posted: Sunday, September 1, 2019

Matteo Piovella MD

A new automated capsulotomy system is effective at providing consistent, circular capsulotomies and reduces the risks of certain complications associated with cataract surgery, according to Matteo Piovella MD.

“There is an initial learning curve associated with it, but once the technology has been mastered it enables the surgeon to create a precise and repeatable circular anterior capsulotomy while reducing the risk of capsular tears,” Dr Piovella told delegates attending the European Society of Ophthalmology (SOE) meeting in Nice, France.

Dr Piovella explained that the Zepto capsulotomy system (Mynosys Cellular Devices) is a disposable, automated device consisting of a disposable handpiece with a silicone suction cup and a nitinol ring made of a nickel-titanium alloy. The application of suction forces the ring against the capsule, with a short pulse of energy causing the ring to generate a hole in the capsule, creating a circular, centred capsulotomy in just 4 milliseconds.

The device integrates seamlessly into the routine steps of cataract surgery with phacoemulsification, noted Dr Piovella, and there is no need for the surgeon to alter his or her normal routine. Instead of using a capsulorhexis forceps or a cystotome, the surgeon uses the automated ring instead.

The current version of Zepto produces a mean capsulotomy diameter of 5.2mm, with the possibility of a paediatric capsulotomy device being developed at a later stage. For pupils smaller than 5.5mm, Zepto can be slid under the iris before suction is engaged and there is no danger of iris tissue being captured by the suction, advised Dr Piovella.

For pupils larger than 6.5mm, the iris tissue will not be in close proximity to the suction cup and will not be captured by the suction. This approach confers a number of clinical benefits, said Dr Piovella, who presented the results of a study using Zepto in 187 eyes of 107 cataract patients.

“It is very quick and provides consistent, high-quality circular capsulotomies with a greater margin of safety compared to a capsulorhexis. The device is also less expensive than femtosecond laser-assisted cataract surgery and provides continuous technical improvements,” he said.

Another benefit of the device is that because the silicone suction cup is transparent it allows the surgeon to preserve visual axis information during the procedure.

In Dr Piovella’s study the mean endothelial cell count at six months was 2,181 compared to 2,249 preoperatively, with under 4% loss of cells over the follow-up period. There were eight anterior radial tears in the first 25 cases, directly related to the learning curve with the device, he said.

Although Zepto works well for routine cataract cases, it may also prove particularly beneficial in more complex cases such as zonular disorders, retinitis pigmentosa and white cataracts, with the only limitation being an anterior chamber depth of at least 1.8 millimetres.

Matteo Piovella:

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