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Purpose: To compare histological analyses of capsulotomies from different laser systems with regard to tissue alteration, laser spot formation, and energy settings., Methods: Four femtosecond laser platforms approved for cataract surgery were evaluated: LenSx (Alcon Laboratories, Inc., Fort Worth, TX), Catalys (Abbott Medical Optics, Santa Ana, CA), Victus (Tecnolas/Bausch & Lomb, Munich, Germany), and LensAR (Topcon, Gamagori, Japan). Ten human anterior lens capsulotomy disks from each laser system were analyzed: five by means of light microscopy and five by transmission electron microscopy (TEM). TEM was used especially to examine the cellular and stromal changes at the cutting edges. The cellular demarcation line was measured at 15 points along the rim and statistically compared with the findings from all laser platforms. Three capsules of each laser platform were prepared for TEM to evaluate the cellular and tissue edges of the laser cuttings., Results: All capsulotomies revealed a circular demarcation zone of different sizes along the cutting edges. Light microscopy showed a radial tissue damage of 36.0 ± 12.3 μm after Victus laser capsulotomy, 8.9 ± 2.9 μm after Catalys laser capsulotomy, 25.2 ± 5.6 μm after LensAR laser capsulotomy, and 39.8 ± 5.1 μm after LenSx laser capsulotomy. Differences between the damaged tissue zones correlated with the laser systems and their energy settings., Conclusions: The use of less energy and larger spot separation led to smaller collateral damaged tissue areas along the cutting edges. The aberrant laser spots along the cutting edge may result in weakening of the remaining tissue, thereby enhancing the risk for capsular ruptures during surgery. [J Refract Surg. 2017;33(10):670-675.]., (Copyright 2017, SLACK Incorporated.)

Purpose: To compare visual recovery and refractive changes between femtosecond laser-assisted cataract surgery and standard cataract surgery., Setting: Center for Vision Science, Ruhr University Eye Clinic, Bochum, Germany., Design: Prospective randomized intraindividual cohort study., Methods: Eyes were treated with femtosecond laser-assisted cataract surgery or conventional phacoemulsification using pulsed ultrasound energy. Both groups had intraocular lens (IOL) implantation. The manifest refraction, corrected distance visual acuity, and anterior chamber depth were determined preoperatively and 2 hours, 3 to 4 days, 1 week, and 1, 2, 3, and 6 months postoperatively to determine the achieved deviation from target refraction, IOL position, and refractive stability., Results: One hundred eyes of 100 patients were treated with femtosecond laser-assisted cataract surgery; the fellow 100 eyes had conventional phacoemulsification. Six months postoperatively, 196 eyes were included and analyzed. At 6 months, 90 eyes (92%) in the femtosecond laser-assisted group and 70 eyes (71%) in the conventional group were within ±0.50 D of the target refractive outcome and 98 eyes (100%) in both groups were within ±1.00 D. The mean refractive spherical equivalent showed no significant change between 1 week and 1 month in the femtosecond laser-assisted group and between 1, 2, 3, and 6 months postoperatively in both groups., Conclusion: Femtosecond laser-assisted cataract surgery yielded faster visual recovery, less deviation from the target refraction, and earlier stabilization of refraction., Financial Disclosure: Dr. Dick is a member of the medical advisory board of Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015. Published by Elsevier Inc.)

Purpose: To evaluate the ease of anterior cortex removal and hydrodissection of the lens in femtosecond laser-assisted cataract surgery compared with standard phacoemulsification., Methods: In the femtosecond laser-assisted cataract surgery group (400 eyes), a femtosecond laser was used for capsulotomy and followed by lens fragmentation. In the standard group, the capsulorhexis was performed manually. In both groups, a normal hydrodissection was set, the nucleus was aspirated with or without ultrasound phacoemulsification energy, and residual cortex removal and posterior capsule polishing were performed using bimanual irrigation/aspiration. The primary end point was the time (in seconds) required for the removal of the cortex from instrument insertion in the eye until aspiration tip removal. Secondary end points were the effective phacoemulsification time, quality of the anterior capsule, and anterior or posterior capsule ruptures., Results: Cortex removal time measured 30 ± 13 seconds (range: 10 to 76 seconds) for the standard group and 27 ± 10 seconds (range: 9 to 72 seconds) for the femtosecond laser-assisted cataract surgery group (P < .005). After laser-assisted capsulotomy, one capsule was still adherent following removal by forceps. No anterior or posterior capsular tears were observed in either group., Conclusions: In femtosecond laser-assisted cataract surgery, the biaxial cortex removal time was comparable with the time in standard phacoemulsification.

Purpose: To compare femtosecond laser-assisted cataract surgery with standard phacoemulsification concerning the incidence of postoperative clinical or subclinical macular edema and the correlation between macular thickness and postoperative intraocular inflammation values., Methods: One hundred four eyes of 104 patients were treated by laser-assisted cataract surgery and the fellow 104 eyes underwent phacoemulsification using pulsed ultrasound energy and intraocular lens implantation in this prospective randomized study. Laser flare photometry was measured preoperatively and at 2 hours, 3 to 4 days, 1 month, 3 months, and 6 months postoperatively. Retinal thickness was measured by spectral-domain optical coherence tomography., Results: Two hundred two eyes (97%) were included and analyzed at 6 months postoperatively. The mean center thickness in the laser group was 210 ± 24 μm at 4 days postoperatively, 214 ± 22 μm at 1 month postoperatively, 219 ± 20 μm at 3 months postoperatively, and 215 ± 22 μm at 6 months postoperatively. The mean center thickness in the standard group was 211 ± 32 μm at 4 days postoperatively, 210 ± 34 μm at 1 month postoperatively, 217 ± 29 μm at 3 months postoperatively, and 209 ± 30 μm at 6 months postoperatively. Laser flare photometry showed higher levels in the standard group at the first postoperative visit 2 hours after surgery compared with the laser group., Conclusions: Femtosecond laser-assisted cataract surgery did not obviously influence the incidence of postoperative macular edema., (Copyright 2014, SLACK Incorporated.)

Purpose: To examine the dynamics of capsular bag changes over 3 months of healing after standard cataract surgery and laser-assisted cataract surgery., Methods: One hundred six eyes of 53 patients with visually significant cataracts were treated with laser-assisted cataract surgery in one eye and standard phacoemulsification in the other. A capsular measuring ring was implanted in both eyes and effective phacoemulsification time was recorded. Capsular bag diameter was measured at six time points within 3 months of follow-up. Intraindividual capsular bag shrinkage was calculated., Results: The laser group required less ultrasound energy to remove the softened nucleus than the standard group (effective phacoemulsification time: 0.03 vs 1.25 sec; P < .005). The laser group had statistically significantly less capsular bag shrinkage than the standard group at all time points from 1 to 3 months (P < .001)., Conclusions: Lens position changes within 3 months postoperatively may be lessened with laser-assisted cataract surgery in comparison to standard phacoemulsification due the decreased capsular bag shrinkage during this period. A tendency toward earlier stabilization of the capsular bag diameter with laser-assisted cataract surgery provides potential for more predictable effective lens position and intraocular lens power calculations., (Copyright 2014, SLACK Incorporated.)

Purpose: To evaluate the feasibility and safety of femtosecond laser-assisted capsulotomy in eyes with intumescent white cataract., Setting: Ruhr University Eye Clinic, Bochum, Germany., Design: Prospective clinical trial., Methods: After femtosecond laser-assisted capsulotomy (Catalys Precision system), phacoemulsification was performed using pulsed ultrasound energy and the effective phacoemulsification time was evaluated. The lenticular capsule disk was stained intraoperatively with trypan blue and pulled out using a microsurgical forceps for further analysis of form and shape., Results: Twenty-five eyes were included in this trial. Automatic optical coherence tomography detection of the anterior capsule was performed successfully in all eyes. Radial anterior tears occurred in 2 eyes, an adherent tongue-like capsule adhesion in 9 eyes, and an incomplete capsulotomy button in 3 eyes. In all cases, the intraocular lens was centered and the implantation was uneventful. The mean deviation from the target diameter of the extracted capsule disks was 60 μm ± 44 (SD)., Conclusion: The use of the femtosecond laser-assisted system for capsulotomy in surgery for intumescent white cataract appears to be safe and technically feasible., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

We present a 39-year-old patient with a penetrating injury of the cornea and anterior lens capsule containing an intralenticular foreign body. One week after the accident, the patient consulted our emergency unit. Clinical examination showed no Seidel II phenomenon. A femtosecond laser-assisted capsulotomy was performed followed by lens removal and intraocular lens implantation. The capsulotomy diameter was increased to 6.7 mm to include the foreign-body area and the break in the anterior capsule. The procedure was uneventful, and the capsule leaf, including the foreign body, was extracted safely., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate intraocular pressure (IOP) during femtosecond laser-assisted cataract surgery using a fluid-filled interface., Setting: Ruhr University Eye Clinic, Bochum, Germany., Design: Prospective clinical trial., Methods: The absolute IOP was measured with a modified Schiotz tonometer before and after laser-assisted cataract surgery with and without a fluid-filled interface (Liquid Optics interface, Catalys Precision Laser System)., Results: The study evaluated 100 eyes. Tonometry and laser cataract surgery were completed successfully in all eyes. The mean preoperative IOP was 15.6 mm Hg ± 2.5 (SD). Upon application of the suction ring and vacuum, the mean IOP rose to 25.9 ± 5.0 mm Hg and remained nearly constant after the laser procedure (27.6 ± 5.5 mm Hg). After removal of the suction ring, the mean IOP was 19.1 ± 4.4 mm Hg. The IOP 1 hour after surgery was not significantly higher than the preoperative values., Conclusions: The results indicate a minor increase in IOP using the fluid-filled interface. This is in strong contrast to substantially higher values reported in the literature with flat and curved applanating contact interfaces., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the effect of femtosecond laser-assisted cataract surgery on effective phacoemulsification time (EPT) with standard cataract surgery., Methods: This prospective clinical trial evaluated the feasibility of using a femtosecond laser system (Catalys Precision Laser System, OptiMedica) to perform capsulotomy and lens fragmentation in the treatment of patients with senile cataract. Patients were evaluated preoperatively with the Lens Opacities Classification System III (LOCS III). Fifty-two patients underwent standard cataract surgery and 57 patients underwent femtosecond laser-assisted cataract surgery in December 2011. Both groups underwent phacoemulsification using pulsed ultrasound energy and EPT was evaluated., Results: Preoperative LOCS III grades were 3.4±0.9 in the femtosecond laser-assisted cataract surgery group and 3.1±0.9 in the standard group. In the femtosecond laser-assisted cataract surgery group, mean laser treatment time was 54.9 seconds and EPT was 0.16±0.21 seconds compared to 4.07±3.14 seconds in the standard group., Conclusions: The use of the femtosecond laser-assisted system in cataract surgery led to a lower EPT compared to the standard procedure., (Copyright 2012, SLACK Incorporated.)

Purpose: To compare the effect of different fragmentation softening grids in femtosecond laser-assisted cataract surgery on effective phacoemulsification time (EPT)., Setting: Ruhr University Eye Clinic, Bochum, Germany., Design: Prospective randomized clinical trial., Methods: The study evaluated the feasibility of using a femtosecond laser (Catalys Precision Laser System) to perform capsulotomy and lens fragmentation in the treatment of patients with senile cataract. Patients were evaluated preoperatively with the Lens Opacities Classification System III (LOCS III). Patients had laser refractive cataract surgery with 350 μm fragmentation grids or with 500 μm fragmentation grids. Both groups had phacoemulsification using pulsed ultrasound energy, and the EPT was evaluated., Results: Eighty patients were treated with 350 μm fragmentation grids and 80 patients with 500 μm fragmentation grids. The mean preoperative LOCS III grade was 3.7 ± 0.8 (SD) in the 350 μm group and 3.5 ± 0.8 in the 500 μm group. The mean laser treatment time was 66.4 ± 14.4 seconds in the 350 μm group and 52.8 ± 11.9 seconds in the 500 μm grid group and the mean EPT, 0.03 ± 0.05 seconds and 0.21 ± 0.26 seconds, respectively., Conclusion: The use of the femtosecond laser-assisted system in cataract surgery with 350 μm grid softening led to a statistically significant lower EPT than the 500 μm grid., Financial Disclosure: Dr. Dick is a member of the medical advisory board of Optimedica Corp. No other author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)