Efficacy of femtosecond laser for anterior capsulotomy in complex white cataracts

Cataract surgery combined with intraocular lens (IOL) implantation is the most performed surgical procedure globally [1]. This surgery improves the visual acuity and quality of life of the patients [1]. Generally, cataracts are classified according to their grade or configuration, among which nuclear, cortical and subcapsular forms stand out [2]. On certain occasions, surgeons can face advanced cataract stages, such as black, white or Morgagnian. White cataract is especially a surgical challenge, with a higher incidence of complications, relying on the skill and experience of the surgeon, since, in this type of case, the anterior capsule is thin and fragile with a tendency to open radially during the capsulotomy; this complication is known as the Argentinian flag [3] sign when trypan blue has been used [4].

Briefly, two types of white cataracts can be differentiated: pearly, in which there is usually no or minimal liquefied cortex, and intumescent or Morgagnian, in which a large amount of liquefied cortex is observed [5]. The capsulorhexis described by Gimbel and Neuhann [6] was a milestone in improving the efficacy of phacoemulsification and IOL implantation in the capsular bag. It is known that the creation of a continuous curvilinear capsulorhexis is a crucial step for further surgical success. However, this manual step, as previously mentioned, can be especially complex in cases of white cataract, due, on the one hand, to loss of the red reflex and, on the other, to the increase in intralenticular pressure in some intumescent cases, which makes the capsulorhexis difficult to perform, with a higher incidence of associated radial tears that can compromise the posterior capsule and ultimately result in vitreous loss [7].

Different procedures have been used to optimize the performance of capsulorhexis in case of white cataract, such as the use of trypan blue [8], high-molecular weight ophthalmic viscosurgical devices [9], two- stage capsulorhexis [10], initial puncture with a 30G needle in an airtight anterior chamber [11], pulsed capsulotomy [12], and femtosecond laser associated cataract surgery (FLACS) [13], among others. The FLACS perfected the performance of the capsulotomy, making this step of the surgery replicable, with great regularity in its shape and size that benefit the effective position of the IOL [13], [14], [15]. It had also proven to be effective in white cataract [13], [14]. However, as far as we know, its use in cases of white cataracts associated with another complex situations has not been still reported.

Our aim is to present a series of clinical cases of white cataract disease associated with several factors such as: pseudoexfoliation, short axial length, nystagmus, albinism, and previous corneal transplantation, reporting our experience in the effectiveness of the FLACS in performing capsulotomy and phacoemulsification in such scenarios.

留言 (0)

沒有登入
gif