Efficacy of Femtosecond Laser-Assisted Capsulotomy: Experimental Evaluation Using the Zonular Dehiscence Model

The purpose of this study was to evaluate experimentally the efficacy of femtosecond laser (FL)-assisted capsulotomy using an eye model with different degrees of zonular dehiscence (ZD).

An eye model with ZD was created by removing the total iris and including the planned range of the ZD in porcine and human cadaver eyes. FL-assisted capsulotomies (laser group) and manual capsulotomies (manual group) were created for the eye model with 0, 45, 135, 180, and 270 degrees of ZD. The continuity, mean diameter, ellipticity, and decentration of the capsulotomy were evaluated using the captured images. The same evaluation of FL-assisted capsulotomies was done for five human cadaver eyes with 180 degrees of ZD.

In the laser group, no differences were seen in the mean diameter, ellipticity, and decentration, although the manual group resulted in significantly larger, ovalized, and decentered capsulotomies with different degrees of ZD (P < 0.001, P < 0.001, and P = 0.0317, respectively). Continuous capsulotomies or capsulotomies with microadhesions were obtained up to 180 degrees of ZD, and incomplete treatment areas were seen in eyes with 270 degrees of ZD. Capsulotomy of the human cadaver eyes with 180 degrees of ZD showed similar results to those of porcine eyes.

In this experimental study, FL-assisted capsulotomy showed favorable results in eyes with between 0 and 180 degrees of ZD compared to conventional manual capsulotomy.

Our experimental model can simulate the capsulotomy in cases with ZD, the results are useful when determining the indication for FL-assisted capsulotomies.