Evolution of the Capsulotomy

For the past several years, one of the most talked-about areas in cataract surgery has been femtosecond laser technology. Part of the attraction to these devices is the increased safety, accuracy, and predictability that the laser can offer in terms of capsulotomy circularity, size, and centration; arguably, however, another part of the attraction is the ability to market the technology as a premium procedure to prospective patients.

It has been shown that the femtosecond laser produces a more circular and accurately sized capsulotomy compared with a manual continuous curvilinear capsulorrhexis (CCC) technique. But how does the laser capsulotomy compare with the manual CCC in terms of edge strength—one of the most important determinants of the capsule’s ability to withstand the manipulations that occur during cataract removal and IOL implantation? While clinical trials comparing edge strength of these two types of capsular opening are under way, other reportedly more cost-effective alternatives for accurate capsulotomy creation are beginning to surface. Early reports on such devices—which include the ApertureRx (International BioMedical Devices), the CapsuLaser (CapsuLaser), and the Zepto (Mynosys)—suggest that edge strength is at least comparable to that of manual CCC and may be up to three times stronger. Others advocate for the use of simpler ring-caliper devices to increase the ease and efficiency of manual CCC without decreasing its edge strength.

This cover focus aims to highlight the new technologies mentioned above and to review not only the structural differences between laser and manual capsulotomies but also the early reports of anterior capsular integrity in laser-assisted cataract surgery. First, in his opening article, Richard Packard, MD, FRCS, FRCOphth, reminds us just how important the advances in capsular opening techniques have been to cataract surgery and celebrates some of the innovators in this area of ophthalmology. n