Optical coherence tomography and 3-dimensional confocal structured imaging system-guided femtosecond laser capsulotomy versus manual continuous curvilinear capsulorhexis

J Cataract Refract Surg. 2014 Dec;40(12):2035-43. doi: 10.1016/j.jcrs.2014.05.032. Epub 2014 Oct 23.


Purpose: To compare the features of capsulotomy obtained during femtosecond laser-assisted cataract surgery with those of continuous curvilinear capsulorhexis (CCC) obtained using a standard manual technique.

Setting: Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy.

Design: Prospective randomized clinical study.

Methods: Candidates for cataract extraction were randomized into 1 of 3 groups as follows: Lensx femtosecond laser-assisted cataract surgery capsulotomy (laser group 1), Lensar femtosecond laser-assisted cataract surgery capsulotomy (laser group 2), and manual CCC (manual group).

Results: Each group comprised 30 eyes (30 patients). The capsulotomies in laser group 1 and laser group 2 showed significantly better circularity than the manual CCCs at 7 days (P<.001). There was a significant correlation between the intended versus achieved capsulotomy size in the 2 laser groups. Both laser groups had better intraocular lens (IOL) centration than the manual group at all timepoints (P<.001). Between-group differences in uncorrected and corrected distance visual acuities were not statistically significant. The residual spherical equivalent and mean absolute error were statistically significantly smaller in the 2 laser groups than in the manual group (P=.038) and increased significantly over time in all the groups (P<.001).

Conclusions: Femtosecond laser capsulotomies showed better circularity with more predictable size than manual CCCs. In addition, IOL centration was better immediately after surgery and over time with better refractive results in the 2 laser groups.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Anterior Capsule of the Lens / surgery*
  • Capsulorhexis / methods*
  • Double-Blind Method
  • Humans
  • Imaging, Three-Dimensional
  • Laser Therapy / methods*
  • Lens Implantation, Intraocular
  • Phacoemulsification / methods*
  • Prospective Studies
  • Pseudophakia / physiopathology
  • Refraction, Ocular / physiology
  • Surgery, Computer-Assisted / methods*
  • Tomography, Optical Coherence*
  • Visual Acuity / physiology