Eyeworld

44 EW CATARACT capsulotomy (purple) is better centered over the optic than the pupil-centered capsulotomy (green) would have been. Additionally, the pupil-centered opening would not have provided 100% overlap of the optic edge. Overall, the scanned capsule method offered the better position in 82% of eyes; 9% were in a better position with a pupil-centered cap- sulotomy; and there was no differ- Model M4 Porous Plate www.ahmedvalve.com 800.832.5327 Visit us at booth #340 Unlike Any Other! Capsulotomy continued from page 42 September 2014 ence in the other 9%. 100% of the scanned capsule eyes had 360-degree optic overlap by the capsule, com- pared to only 78% of the eyes with pupil-centered capsulotomies. We found that scanned cap- sule centration usually results in a slightly more superior and nasal capsulotomy than if it were pupil centered. As a refractive surgeon, I find it interesting that this is similar to the slightly superonasal position of the undilated pupil relative to the limbus. Based on these results, my current practice is to make a 5.0-mm capsulotomy and to always choose the scanned-capsule method if the pupil is well dilated. In an eye with poor dilation, this will sometimes result in a capsulotomy plan that is too close to the iris edge to fit within the safety parameters. In such cases, I will center on the pupil instead. Further research is needed to understand the implications of this small study. I believe we are only just beginning to refine our understanding of the factors that influence ELP, determine where and how to best center the capsulotomy, and imagine what other elements of cataract surgery we might be able to improve with the aid of the high- resolution imaging built into these femtosecond lasers. EW References 1. Hill WE. Effective lens position following laser anterior capsulotomy. Paper PA005, presented at the 2011 American Academy of Ophthalmology meeting, Orlando, Fla. 2. Friedman NJ et al. Femtosecond la- ser capsulotomy. J Cataract Refract Surg 2011;37(7):1189–98. Erratum in: J Cataract Refract Surg 2011;37(9):1742. 3. Nagy ZZ, Kranitz K, Takacs AI, et al. Comparison of intraocular lens decentra- tion parameters after femtosecond and manual capsulotomies. J Refract Surg 2011;27(8):564–9. 4. Kranitz K, Takacs A, Mihaltz K, et al. Femtosecond laser capsulotomy and manual continuous curvilinear capsulorrhexis pa- rameters and their effects on intraocular lens centration. J Refract Surg 2011;27(8):558–63. Editors' note: Dr. Bafna is in practice at the Cleveland Eye Clinic in Brecksville, Ohio. He has financial interests with AMO. Contact information Bafna: drbafna@clevelandeyeclinic.com "I believe we are only just beginning to refine our understanding of the factors that influence ELP, determine where and how to best center the capsulotomy, and imagine what other elements of cataract surgery we might be able to improve with the aid of the high-resolution imaging built into these femtosecond lasers."

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