Femtosecond laser capsulotomy versus manual capsulotomy: a Meta-analysis

AIM: To perform a Meta-analysis on the precision and safety of femtosecond laser (FSL) capsulotomy compared with manual continuous curvilinear capsulotomy (CCC). METHODS: We searched PubMed, EMBASE, Web of Science, the Cochrane Library databases, and Clinical Trials.gov that maintained our inclusion criteria. Reference lists of retrieved articles were also reviewed. The effects of morphology of capsulorhexis and the tears of anterior capsule were calculated by using random-effect models. RESULTS: We identified 4 randomized and 7 nonrandomized studies involving 2941 eyes. The diameter of capsulotomy and the rates of anterior capsule tear showed no statistically difference between FSL group and manual group (MD=0.03; 95%CI, -0.03 to 0.09, P=0.31), and (OR=1.40; 95%CI, 0.28 to 6.97, P=0.68) respectively. In terms of the circularity of capsulotomy, FSL group had a more significant advantage than the manual CCC group (MD=0.09; 95%CI, 0.05 to 0.12, P<0.0001). CONCLUSION: Our Meta-analysis shows that FSL can perform a capsulotomy with more precision and higher reliability than manual CCC. The results in diameter of capsulotomy and the rate of anterior capsule tears was no significant difference between FSL and manual CCC groups. However in terms of circularity, the FSL was superior to the manual procedure.     

Analysis of the capsule edge after Fugo plasma blade capsulotomy, continuous curvilinear capsulorhexis, and can-opener capsulotomy

PURPOSE: To compare the quality of the edges of anterior capsulotomies performed in porcine eyes using 3 different techniques. SETTING: David J. Apple, MD Laboratories for Ophthalmic Devices Research, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA. METHODS: Four porcine eyes were submitted to the center in 10% neutral buffered formalin. The cornea of the eyes had been removed, and a continuous capsulotomy had been performed in each eye using the Fugo plasma blade. To provide morphologic correlation, 4 additional porcine eyes were used in the study. In 2, a manual continuous curvilinear capsulorhexis (CCC) was performed after the cornea or cornea/iris was removed and in the other 2, a can-opener capsulotomy (COC) was performed. The eyes were then placed in 10% neutral buffered formalin. Gross (macroscopic) and microscopic analysis of each eye was performed, and photographs were taken. One eye in each group was also prepared and analyzed under scanning electron microscopy (SEM). RESULTS: The capsulotomy margin in the Fugo blade group presented some regularly spaced tags directed centrally with smooth edges at the base. Such a configuration would not interfere with the dynamics of the capsulorhexis sphincter and would generally not lead to radial tears. The smooth and regular nature of the capsulotomy margin in the CCC group was confirmed by gross and microscopic examinations of the eyes. The capsulotomy margin in the COC group presented some sharp notches directed outward, irregularly spaced, and irregular in shape. These are known to have a tendency to extend and form radial tears. CONCLUSION: Although performance of an anterior capsulotomy with the Fugo blade was associated with some margin irregularities, the geometry of the centrally directed tags prevented them from becoming the site of radial tear formation. The base of the capsulotomy performed with the Fugo blade appeared to be almost as smooth and regular as in the CCC under SEM evaluation.     

电切破囊在白内障术中的应用价值

目的:探讨电切破囊在白内障术中的应用价值。方法:选择各种类型的白内障621例,在手术中分别以连续环型撕囊或电凝撕囊仪予以切囊,观察术中前囊膜有无放射状撕裂。结果:使用电切破囊发生前囊膜放射状撕裂的仅1例。结论:电切破囊可有效防止初学者前囊膜放射状撕裂,可被初学者很快掌握。     

电子撕囊仪在婴幼儿先天性白内障手术中的应用

目的探讨电子撕囊仪在婴幼儿先天性白内障手术中的应用价值和临床效果。方法回顾性分析在我院确诊并进行手术的先天性白内障患儿52例(92只眼)的临床资料。手术中采用电子撕囊仪环形撕开前囊膜。对于机化混浊的后囊膜使用电子撕囊仪环形撕后囊,再行玻璃体切割。观察手术中及术后晶体囊膜情况。随访时间6~17个月。结果 92只眼(100%)使用电子撕囊仪成功完成前囊膜撕开,未改用其他撕囊方法。83只眼一次性形成光滑的前囊圆形切口。9只眼在撕前囊时出现放射状撕裂,立即反方向进行撕囊,均完成撕囊。撕前囊膜成功率90.2%。13只眼一次性形成光滑的后囊圆形切口,撕后囊膜成功率100%。术后1个月,术眼囊膜边缘呈不同程度的机化、变白。术后6个月,所有术眼囊膜边缘呈瓷白色,囊袋发生不同程度皱缩。结论对于婴幼儿先天性白内障手术中囊膜的处理,电子撕囊仪与手法撕囊相比,具有更加广泛的适用性和有效性。     

Comparison of anterior vitrectorhexis and continuous curvilinear capsulorhexis in pediatric cataract and intraocular lens implantation surgery: a 10-year analysis.

PURPOSE: To analyze the rate of inadvertent anterior lens capsular tears with vitrectorhexis or continuous curvilinear capsulorhexis (CCC) in pediatric cataract and intraocular lens (IOL) implantation surgery between January 1, 1997, and December 31, 2006. METHODS: Retrospective chart review, collecting for each eye: age at cataract surgery, type of anterior capsulotomy, any tearing of the capsule, and if yes, details of the tear. RESULTS: A total of 737 eyes were reviewed. Cases with a ruptured lens capsule that occurred prior to surgery were excluded. Eyes that received an anterior capsulotomy by any other method (n = 27) or eyes that did not receive an IOL (n = 100) were reviewed but excluded from final comparative analysis. Of the remaining 339 eyes, 19 eyes (5.6%) were noted to develop an anterior capsule tear (vitrectorhexis, 12 of 226 eyes, 5.3%; CCC, 7 of 113, 6.2%). These tears occurred during anterior capsulotomy in seven eyes, hydrodissection in one, cataract removal in three, and IOL insertion/manipulation in eight. In eyes operated for cataract at or before 72 months of age, the manual CCC technique was more likely to develop a tear (relative risk, 3.09) compared with eyes of older children (>72 months of age), where the vitrectorhexis technique was more likely to develop a tear (relative risk, 3.14). CONCLUSIONS: Vitrectorhexis is well suited for use in children less than 6 years of age due to their highly elastic anterior lens capsule. For children aged 6 years and older, manual CCC is the best technique because, by that age, capsule control and ease of capsulotomy completion has improved.     

二次撕囊术在白内障超声乳化摘除及人工晶状体植入术中的应用

目的 :探讨在白内障超声乳化摘除及人工晶状体植入术中行二次撕囊术 (secondarycapsulorhexis)的方法和作用。方法 :对 6例因皮质膨胀或液化眼行计划性的二次撕囊 ;10例行非计划性的二次撕囊 ,其中 3例因撕囊口过小难于植入囊袋内位固定人工晶状体 ,3例因超声乳化白内障摘除时前囊膜切迹破裂 ,4例因撕囊口偏中心 ,为防止囊膜收缩综合征发生以致遮盖瞳孔区而行二次撕囊。结果 :二次撕囊术后完成前囊膜连续曲线形撕囊 13眼 ,16眼均植入囊袋内位固定人工晶状体。结论 :二次撕囊术可使晶状体皮质膨胀或液化的白内障眼易于完成前囊膜连续曲线形撕囊 ;可避免白内障术中前囊膜切迹破裂以至进一步放射状撕裂 ;可维持完整曲线形撕囊口边缘 ,防止发生人工晶状体植入后光学部偏中心 ,囊襻异位 ;使过小撕囊口易于植入囊袋内位固定人工晶状体 ;使撕囊口偏下而让难于被吸除的上方赤道部残收稿日期 :2 0 0 2 -0 3 -2 6;修回日期 :2 0 0 2 -0 6-0 4作者简介 :周坚强 ( 1973 -) ,男 ,嘉兴人 ,眼科医师。通信作者 :周坚强 (E -mail:zhjq @mail.jxptt.zj.cn)。余皮质易于被吸除 ;可减少或避免过小前囊膜撕囊口或明显偏中心撕囊口发生囊膜收缩综合征 (capsulecontractionsyn drome)等。     

Ultrasound biomicroscopy examination of intraocular lens haptic position after phacoemulsification with continuous curvilinear capsulorhexis and extracapsular cataract extraction with linear capsulotomy.

PURPOSE: Intraocular lens (IOL) haptic position in 35 eyes that had undergone cataract surgery was examined with ultrasound biomicroscopy (UBM). METHODS: In a prospective randomized study the patients were operated by phacoemulsification using continuous curvilinear capsulorhexis (CCC) (group I) or by extracapsular cataract extraction (ECCE) using linear capsulotomy (group II). Ultrasound biomicroscopy was used to localize both haptics of the implanted intraocular lenses and to measure anterior chamber depth (ACD), iris thickness and anterior chamber angle. The inflammatory reaction in the anterior chamber was assessed with laser flare photometry. Slit lamp examination was performed. RESULTS: Both IOL haptics were found in the lens capsule in all 18 eyes in group I. In group II one of the haptics was located out of the capsule in 7 of 17 eyes (41%). The difference is statistically significant (p=0.01). Postoperatively mean ACD measured with the UBM was 4.06+/-0.30 mm in group I and 3.64+/-0.24 mm in group II (p=0.00025). CONCLUSION: The UBM examinations indicate that phacoemulsification with continuous curvilinear capsulorhexis is a more reliable technique than ECCE with linear capsulotomy to achieve implantation of the intraocular lens haptics in the capsular bag.     

Star CanVac-continuous curvilinear capsulorhexis - A novel,safe rhexis technique in intumescent total cataracts

Achieving a complete uniform capsulorhexis in an intumescent cataract is perhaps the most crucial and challenging step for surgeons. Star CanVac CCC is a new manual technique for creating a continuous curvilinear capsulorhexis (CCC) in intumescent total cataracts. Small centripetal tears in the shape of a star are created in the center of the anterior lens capsule by using a 26-G cystotome. This allows equal distribution of forces secondary to increased intralenticular pressure, thereby avoiding unidirectional or bidirectional tear extension. Subsequently, a 25-G flat-tipped fine cannula connected to a syringe is used to hold the free capsular flap. The piston of the syringe is withdrawn to create a stable suction pressure, and the rhexis is completed without withdrawing the instrument from the anterior chamber. Our technique is safe, affordable, and an alternative method to routine CCC or expensive techniques such as Femto or Zepto capsulotomy for white intumescent cataracts.     

Elastic properties and scanning electron microscopic appearance of manual continuous curvilinear capsulorhexis and vitrectorhexis in an animal model of pediatric cataract

PURPOSE: To compare the tear resistance of anterior capsulotomies using manual continuous curvilinear capsulorhexis (CCC) and vitrector-cut capsulotomy (vitrectorhexis) techniques in an animal model of the pediatric eye and in 2 pairs of human infant eyes. SETTING: Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Continuous curvilinear capsulorhexis and automated vitrectorhexis capsulotomy techniques were performed in 20 pig eyes, 10 with each technique. The capsules were then stretched until they ruptured. The forces required for rupture after each technique were compared. The forces required for rupture of the pig eye lens capsule were also compared with those required for the human infant eye lens capsule. Scanning electron microscopy was performed in each group following intraocular lens (IOL) insertion. RESULTS: All capsules stretched adequately for IOL insertion. The percentage of stretch prior to rupture was higher in the capsulorhexis group (mean 157%, range 147% to 169%) than in the vitrectorhexis group (mean 135%, range 124% to 147%) (P < .001). The percentage of stretch in the human infant eyes was not statistically different from that in the porcine eyes (P > .05). CONCLUSIONS: The manual CCC offered greater resistance to capsule tearing than the vitrectorhexis and also revealed a more smooth, regular edge. It therefore remains the gold standard. However, the vitrectorhexis displayed more than adequate resistance to unwanted anterior capsule tears when used for IOL insertion through capsulotomy sizes currently used in clinical practice.     

无灌注超乳针头截囊减张法在膨胀性白色白内障手术中的应用

目的:观察应用无灌注超乳针头截囊减张法治疗膨胀性白色白内障的效果。方法:回顾性分析宝丰县人民医院2017年1月至2020年2月膨胀性白色白内障315例(340眼)的临床资料。所有患者按手术方式分为两组：常规组,常规撕囊法手术69例(82眼);减张组,采用无灌注超乳针头截囊减张法撕囊手术246例(258眼)。观察两组术后...     

Posterior continuous curvilinear capsulorhexis. An experimental study with clinical applications.

The posterior continuous curvilinear capsulorhexis technique has been advocated in cases of posterior capsule rupture during extracapsular cataract extraction. The authors compared posterior continuous curvilinear capsulorhexis with posterior capsular sharp-edged tears. Two different types of forces were experimentally created on the posterior capsule of 30 human eyes obtained after death: (1) implantation and dialing of posterior chamber intraocular lenses (PC IOLs) and (2) increased intravitreal pressure by injection of balanced salt solution. All posterior capsular tears extended toward the equator, causing major capsular defects. In contrast, the posterior continuous curvilinear capsulorhexis remained intact in all cases. This experimental study proves that in cases where an inadvertent posterior capsular tear occurs, a posterior continuous curvilinear capsulorhexis is useful in preventing further capsular damage. Also, in cases where a posterior capsulotomy is indicated, a smooth edge created by a posterior continuous curvilinear capsulorhexis may be useful to maintain the integrity of the capsular bag for PC IOL capsular implantation.     

Comparison of various capsulectomy techniques in cataract surgery. An experimental study]

Radial tears at the edge of an anterior capsulectomy are often associated with the occurrence of intraocular lens (IOL) loops coming out of the capsular bag with subsequent IOL decentration. We analyzed the incidence of radial tear formation in 40 human eyes obtained postmortem. These eyes were randomly assigned to four groups: "can opener," linear capsulotomy, capsulopuncture ("postage stamp"), and continuous curvilinear capsulorhexis (CCC). The CCC appeared to be much less likely to be associated with anterior capsular radial tears as opposed to the other three techniques. With the nucleus expression technique used in this study, radial tears occurred in all cases of "can opener," linear capsulotomy and capsulopuncture, whereas no tears occurred with the CCC technique. The results of this study show that CCC is currently the best available anterior capsulectomy procedure for minimizing the incidence of radial tears and sequelae such as decentration.     

超声乳化针头破囊减压法在膨胀期白内障手术中的临床应用研究

目的　探索超声乳化针头在膨胀期白内障手术中对张力较大的前囊膜进行破囊减压后再行连续环形撕囊的安全性。方法　回顾性分析常规撕囊组３３例３３眼膨胀期白内障患者术中采用截囊针刺囊时的炸囊率、撕囊镊撕囊时的连续环形撕囊成功率及超声乳化完成率;前瞻性分析超声乳化针头破囊减压（ｐｈａｃｏｅｍｕｌｓｉｆｉｃａｔｉｏｎｎｅｅｄｌｅｃａｐｓｕｌｏｔｏｍｙｄｅｃｏｍｐｒｅｓｓｉｏｎ,ＰＮＣＤ）组２７例２７眼膨胀期白内障患者术中应用针头破囊减压时的炸囊率、撕囊镊撕囊的连续环形撕囊成功率及超声乳化完成率。对两组上述３项结果分别进行统计学分析。结果　常规撕囊组炸囊率为４８．５％,其中２８眼有明显皮质溢入前房内,导致视野模糊;ＰＮＣＤ组炸囊率３．７％,术野清晰,破囊减压的成功率为９６．３％;常规撕囊组明显高于ＰＮＣＤ组,两组比较差异有统计学意义（χ２＝１５．８９５,Ｐ＝０．０００）。常规撕囊组连续环形撕囊成功率为３９．４％,ＰＮＣＤ组为７７．８％;常规撕囊组超声乳化完成率为４５．５％,ＰＮＣＤ组为８５．２％。连续环形撕囊成功率和超声乳化完成率ＰＮＣＤ组均高于常规撕囊组,两组比较差异均有统计学意义（χ２＝８．９１０,Ｐ＝０．００３;χ２＝９．９２６,Ｐ＝０．００２）。常规撕囊组中有２眼发生后囊膜破裂,人工晶状体置于睫状沟;ＰＮＣＤ组无１例严重并发症,人工晶状体均置囊袋内。结论　ＰＮＣＤ法能显著提高膨胀期白内障连续环形撕囊的成功率,降低手术难度,提高手术效率。     

Continuous curvilinear capsulorhexis in intumescent or hypermature cataract with liquefied cortex

We describe a technique to prevent milky liquefied cortical matter from obscuring the view of the anterior chamber and radial tears caused by high intracapsular pressure in eyes with hypermature or intumescent cataract. The continuous curvilinear capsulorhexis (CCC) is created in a sealed anterior chamber without capsule staining or viscoelastic material. Ninety-four consecutive CCCs were performed by a single surgeon over 24 months using the method. A successful CCC was achieved in all eyes. Four cases had complications that occurred late in the surgery and were not related to the CCC.     

An experimental study of the surgical trauma on the rabbit's lens suspensory apparatus after cataract surgery]

Extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens (PC-IOL) implantation requires that the posterior capsule and the zonules remain sufficiently intact. To assess the surgical trauma on the lens suspensory apparatus of the enucleated rabbit eye, we developed a new fine pressure gauge that could quantitate its strength. The cornea and the iris of enucleated eyes were removed to allow clear visualization of the anterior surface of the lens to the equator. Afterwards several types of anterior capsulotomy were performed for ECCE and PC-IOL implantation. And then the lens of the pseudophakic eye was vertically pressed with the plastic rod of the fine pressure transducer, and the strength of the lens suspensory apparatus was simultaneously measured. The strength of the lens suspensory apparatus of the pseudophakic eye decreased approximately 35% compared with that of the phakic eye. Moreover the integrity of the lens capsule of animals with circular capsulorhexis with tears or linear capsulotomy decreased approximately 43% compared with that of continuous circular capsulorhexis (CCC) and also zonular rupture and vitreous loss occurred as a result of the expansion of radial tears in the anterior capsule. The present study indicates that the strength of the lens suspensory apparatus decreases with cataract surgery, suggesting that much more attention to cataract surgery is needed if the anterior capsule had radial tears. It is also suggested that CCC is the best type of anterior capsulectomy procedure.     

Two-stage capsulorhexis for endocapsular phacoemulsification

The continuous tear anterior capsulotomy or capsulorhexis technique is important for safe, successful cataract extraction and intraocular lens (IOL) implantation surgery. A two-stage continuous tear capsulotomy or capsulorhexis extends the possibility of achieving continuous tear capsulotomy to challenging and complicated cases. In endocapsular phacoemulsification this technique preserves the integrity of the capsule because it prevents the extension of radial tears in the capsule and thus facilitates safe cataract extraction and secure in-the-bag IOL placement. The benefits and advantages of the continuous tear capsulotomy are preserved by two-stage capsulorhexis.     

Capsule contraction syndrome

AIM: To analyse the occurrence of the anterior capsule contraction following cataract surgery. Capsule contraction syndrome (CCS) is defined as an extreme reduction in diameter of anterior capsulectomy, capsular bag diameter and, occasionally, displacement of the IOL after extracapsular cataract extraction. It is relatively frequent in pseudoexfoliation, advanced age, in association with uveitis, pars planitis and myotonic muscular dystrophy. MATERIALS AND METHODS: 5965 eyes of patients were operated on cataract between 1.01.1994 and 31.12.1997 in Tadeusz Krwawicz Chair of Ophthalmology and 1st Eye Hospital, Medical School in Lublin. Two types of surgical procedures were performed: "divide and conquer" phacoemulsification with 4.5-8 mm continuous curvilinear capsulorhexis (3385 eyes) and extracapsular cataract extraction with "can opener" capsulotomy (2580 eyes). RESULTS: 20 cases of clinically apparent CCS were referred to the Department: in the course of intensive postoperative inflammation--5, in patients over 80--4, in pseudoexfoliation syndrome--2, myotonic dystrophy--1, ectopia lentis--2, other causes--6. In order to improve visual acuity in 4 cases surgical removal of the distorted and opaque anterior capsule was performed, in 3 cases relaxing radial tears were done, in 3 cases secondary anterior capsulotomy was performed using Q-switched Nd:YAG laser. CONCLUSIONS: In cases where the occurrence of CCS is especially high large diameter capsulorhexis should be performed and IOL designed to provide maximal peripheral capsular bag expansion should be implanted.     

Histology of anterior capsule edges produced by CCC and DC

We compared the postoperative characteristics of the anterior capsule edges produced by two incision techniques: continuous curvilinear capsulorhexis (CCC) and diathermy capsulorhexis (DC). We examined the incised rims of human and animal capsules histologically and also compared the configuration and strength of the rims produced in animal experimentation. Histological examination of rabbit lenses revealed that 0.5 seconds was sufficient for coagulation of the anterior capsule: longer times caused deeper cortical tissue damage. Experimentally produced small capsulorhexis (3.5 mm diameter) with DC produced edges were less elastic than with CCC when tension was applied.     

白内障手术中后囊硬性斑的处理

目的：探讨白内障患者后囊“硬性斑”的诊断及处理方法。方法：根据术前裂隙灯检查和手术中证实硬性斑的不同情况，选择后囊处理方式；首选“oerHi”环形撕囊仪环形撕囊，次之选用刺开撕囊，特殊的硬性斑用不同的环形切囊法。结果：oerHi环形撕囊仪5眼无1眼出现玻璃体溢出晶状体囊袋内，而刺开撕囊2眼有1眼玻璃体溢出晶状体囊袋内、环形切囊2眼均出现玻璃体溢出晶状体囊袋内，给予前段玻璃体切除，本组9眼人工晶状体均植入晶状体囊袋内。结论：用oerHi环形撕囊仪环形撕后囊“硬性斑”，安全、简便。刺开撕囊时，勿伤及玻璃体前膜，深度掌握有难度，环形撕囊时需做前段玻璃体切除准备。     

Nd:YAG激光治疗晶体囊阻滞综合征的临床观察

目的：总结晶体囊袋阻滞综合征的临床特点并评价Nd:YAG激光的治疗效果。方法：对6例晶体囊袋阻滞综合征的临床特点进行回顾性分析,其中4例使用科以人7970Nd:YAG激光机行Nd:YAG激光前后囊膜切开术,平均能量4．7mJ,平均击发69次。结果：6例晶体囊袋阻滞综合征共同表现为连续环形撕囊术后人工晶体光学面被连续环行撕囊口阻塞,晶体囊袋形成密闭的液性腔,后囊膜向后膨隆。4例Nd:YAG激光前后囊膜切开成功,视力明显提高,后囊膜复位。结论：晶体囊袋阻滞综合征是白内障手术并发症之一,对术后迟发膨胀型者,Nd:YAG激光前后囊膜切开术是安全、有效的治疗方法。