Electron microscopy of laser capsulotomy edge: Interplatform comparison.

Area of Science:

• Ophthalmology
• Surgical Technology
• Biomedical Engineering

Background:

• Femtosecond laser technology is increasingly used for cataract surgery.
• Morphological differences between laser-assisted and manual capsulorhexis require detailed investigation.
• Ensuring precision in capsulotomy creation is crucial for surgical outcomes.

Purpose of the Study:

• To conduct a morphological comparison of capsulotomy edges.
• To evaluate edges created by commercial femtosecond laser platforms against manual capsulorhexis.
• To assess smoothness, homogeneity, and anomalies in capsulotomy creation.

Main Methods:

• Experimental study in a private clinic setting.
• Collected capsules from Lensx, Victus, and Catalys laser platforms, plus manual capsulorhexis.
• Analyzed scanning electron microscopy images for edge variation (CoV) and homogeneity (GLCM), noting anomalies like tags.

Main Results:

• Manual capsulorhexis edges were smoother than all tested laser platforms based on CoV.
• Most lasers produced more homogenous capsulotomies than manual, except Lensx post-soft-fit.
• Anomalies such as tags and misdirected pulses were observed with specific laser platforms.

Conclusions:

• Femtosecond laser capsulotomies are approaching the smoothness of manual capsulorhexis.
• The Lensx post-soft-fit platform demonstrated the fewest anomalies and smallest metric differences compared to manual methods.
• Continued refinement of laser platforms may further improve capsulotomy quality.