Comparison of Continuous Curvilinear Capsulorhexis Parameters between Femtosecond Laser and Conventional Cataract Surgery

Jae Hong Park; Kyung Heon Lee; Dong Jun Lee

doi:10.3341/jkos.2014.55.12.1800

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Park, Lee, and Lee: Comparison of Continuous Curvilinear Capsulorhexis Parameters between Femtosecond Laser and Conventional Cataract Surgery

Original Article

J Korean Ophthalmol Soc 2014;55(12):1800-1807.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.12.1800

Comparison of Continuous Curvilinear Capsulorhexis Parameters between Femtosecond Laser and Conventional Cataract Surgery

Jae Hong Park, MD, Kyung Heon Lee, MD, Dong Jun Lee, MD

Busan Sungmo Eye Hospital, Busan, Korea

Address reprint requests to Dong Jun Lee, MD Busan Sungmo Eye Hospital, #409-1 Haeundae-ro, Haeundae-gu, Busan 612-823, Korea, Tel: 82-51-743-0775, Fax: 82-51-743-0776, E-mail: hanwave2@gmail.com

Received 7 February 2014 Revised 4 July 2014 Accepted 17 November 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare parameters of femtosecond laser and manual continuous curvilinear capsulorhexis (CCC) using anterior segment optical coherence tomography (AS-OCT).

Methods

Femtosecond laser cataract surgery was performed in 30 eyes of 30 patients, and conventional cataract surgery with a manual CCC in 30 eyes of 30 patients. One month after surgery, CCC diameters, circularity of capsulotomy, and distance between the CCC and pupil center were analyzed using the AS-OCT.

Results

Mean maximal CCC diameter was 4.96 ± 0.23 mm in the femtosecond laser group, and 4.70 ± 0.82 mm in the manual CCC group. Mean minimal CCC diameter was 4.91 ± 0.23 mm in the femtosecond group, and 4.48 ± 0.64 mm in the manual CCC group showing significant difference between the two groups (p = 0.000). Circularity of capsulotomy was 0.99 ± 0.01 in the femtosecond group and 0.91 ± 0.13 in the manual CCC group and was statistically different between the 2 groups (p = 0.000). The distance from the CCC center to the pupil center was 0.18 ± 0.09 mm in the femtosecond group and 0.26 ± 0.17 mm in the manual CCC group. The CCC center was closer to the pupil center in the femtosecond than in the manual CCC group (p = 0.038).

Conclusions

Properly sized and shaped capsulotomy can be expected in femtosecond laser CCC compared with manual CCC.

Keywords: Capsulotomy, Circularity, Femtosecond cataract surgery

References

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Figure 1.

Anterior segment optical coherence tomography (AS-OCT) images of manually created continuous curvilinear capsulorhexis (CCC) (red line). (A) With CASIA (Tomey, Tokyo, Japan), pupil center could be automatically calculated and setted as (x = 0, y = 0) mm. (B) Displayed value (x, y) of the red point means the distance from pupil (mm). (C) To get the value of CCC center, the values of 8 points in manual CCC margin (per 45 degree) were measured. (D) The mean value of 8 points are presented at the bottom of the image, and displayed as CCC center (red arrow). (E) Intraocular lens (IOL) margin is presented as yellow line. To get the value of IOL center, the values of 8 points in IOL margin (per 45 degree) were measured. (F) CCC center (red arrow) and the value of CCC center (red rectangle), IOL center and the value of IOL center (yellow rectangle).

Figure 2.

Anterior segment optical coherence tomography (AS-OCT) images of femtosecond laser created continuous curvilinear capsulorhexis (CCC) (red line). (A) Note the perfectly round and regularly shaped CCC. Intraocular lens (IOL) margin is presented as yellow line. (B) The value of femtosecond laser CCC center was calculated by the same method as manual CCC. (C) The value of femtosecond laser CCC center is presented at the bottom of the image. (D) CCC center (red arrow) and the value of CCC center (red rectangle), IOL center and the value of IOL center (yellow rectangle).

Table 1.

Demographic data of the patients

Characteristic	Femtosecond CCC	Manual CCC	p-value
Number of eyes (patients)	30 (30)	30 (30)
Age (years)	64.5 ± 9.1	68.2 ± 9.2	0.188
Sex (male:female)	8:22	5:25	0.347^*
MRSE (diopter)	−0.66 ± 2.18	−0.36 ± 5.26	0.811
Axial length (mm)	24.04 ± 1.59	23.66 ± 0.90	0.249
ACD (mm)	3.28 ± 0.52	3.03 ± 0.64	0.190
Mean corneal power (diopter)	43.66 ± 1.93	44.07 ± 1.66	0.413
Intraocular lens (number)
Akreos Adapt AO^†	14	0
iSert 251^‡	10	0
SN6AT^§	3	20
SN6AD^∏	3	10

Values are presented as mean ± SD unless otherwise indicated.

CCC = continuous curvilinear capsulorhexis; MRSE = manifest refraction spherical equivalent; ACD = anterior chamber depth.

^* Chi-square test;

^† Bausch & Lomb Incorporated, Rochester, NY;

^‡ HOYA corporation, Tokyo, Japan;

^§ AcrySof IQ Toric IOL, Alcon laboratories, Inc., Fort Worth, TX;

^∏ AcrySof IQ ReSTOR, Alcon laboratories, Inc., Fort Worth, TX.

Table 2.

Parameters of capsulorhexis and intraocular lens decentration between the 2 groups 1 month after surgery

Parameter	Femtosecond CCC	Manual CCC	p-value
Maximal CCC diameter (mm)	4.96 ± 0.23	4.70 ± 0.82	0.119
Minimal CCC diameter (mm)	4.91 ± 0.23	4.48 ± 0.64	0.000
Circularity	0.99 ± 0.01	0.91 ± 0.13	0.000
Distance from CCC center to pupil center (mm)	0.18 ± 0.09	0.26 ± 0.17	0.038
Distance from CCC center to IOL center (mm)	0.27 ± 0.13	0.24 ± 0.16	0.464
Distance from pupil center to IOL center (mm)	0.25 ± 0.18	0.23 ± 0.13	0.529

Values are presented as mean ± SD.

CCC = continuous curvilinear capsulorhexis; IOL = intraocular lens.

Table 3.

Comparison of visual and refractive outcomes between the 2 groups 1 month after surgery

	Femtosecond CCC	Manual CCC	p-value
UCDVA (log MAR)	0.13 ± 0.14	0.21 ± 0.23	0.122
BCVA (log MAR)	0.06 ± 0.10	0.08 ± 0.12	0.628
Spherical equivalent (diopter)	−0.32 ± 0.37	−0.42 ± 0.63	0.308
Target SE (diopter)	−0.29 ± 0.15	−0.46 ± 0.67	0.352
Mean numeric error (diopter)	0.03 ± 0.34	−0.04 ± 0.32	0.463
MAE within 0.5 diopter (%)	96.6	93.3	0.676

Values are presented as mean ± SD.

CCC = continuous curvilinear capsulorhexis; UCDVA = uncorrected distance visual acuity; BCVA = best corrected distance visual acuity; SE = spherical equivalent; MAE = mean absolute error.

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