Clinical performance in continuous curvilinear capsulorhexis creation supported by a digital image guidance system

To test whether a default capsulorhexis diameter could be attained more precisely when manual continuous curvilinear capsulorhexis (CCC) creation was supported by a biomorphological detection unit.

Ruhr University Eye Hospital, Bochum, Germany.

Prospective interventional study.

Patients were assigned to either of 2 groups. In the first group, a digital image system was applied to guide capsulorhexis. In the second group, the CCC was created without digital support. Postoperatively, horizontal and vertical capsulorhexis dimensions were measured. A set target diameter of 5.5 mm was compared with intraoperative and postoperative CCC diameters, which were also compared with each other. The number of eyes with postoperative CCC diameters outside the reference range of 4.5 to 6.0 mm was assessed.

In 427 eyes, the capsulorhexis size was assessed. Digital image guidance was applied in 203 eyes. Intraoperatively, horizontal capsulorhexis diameters created with surgical guidance differed significantly less from the target diameter than in the control group (P < .001). Eyes treated with surgical guidance differed significantly less from the target diameter (P < .001). Analogously, vertical capsulorhexis diameters differed significantly less from the target when digital support was used, intraoperatively and postoperatively (P < .001). In 418 eyes, postoperative diameters were significantly larger than intraoperatively in both directions (P < .001). Vertical CCC diameters were more frequently within the reference range intraoperatively and postoperatively with surgical guidance (P = .009). Horizontally, eye tracking showed accordance with the target diameter in 87.6% (controls: 91.7%).

Intraoperative image guidance facilitated CCC creation significantly during standard phacoemulsification.