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Causes of posterior capsule rupture during femtosecond laser fragmentation of cataracts

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Session Details

Session Title: Femtolaser-Assisted Cataract Surgery (FLACS) I

Session Date/Time: Sunday 08/10/2017 | 08:00-10:00

Paper Time: 08:56

Venue: Room 3.6

First Author: : R.Bellucci ITALY

Co Author(s): :    M. Cargnoni   C. Bellucci                 

Abstract Details


Femtosecond laser assisted cataract surgery (FLACS) has been performed for 8 years so far, still some problems occasionally arise, like the possible rupture of the posterior capsule by the laser itself during lens fragmentation. The possible causes of these ruptures have been investigated to provide suggestions how to avoid them.


Different laser centres in Italy


A total of six cases were examined, where the posterior capsule appeared to be broken while the anterior capsulotomy was intact. Surgery caused nucleus slippage into the vitreous cavity in 3 eyes, fragment slippage in 2 eyes, and anterior vitrectomy with optic capture of the IOL in 1 eye. All the eyes eventually required vitreoretinal surgery, in one eye because of retinal detachment. The videos of the relevant laser treatments were reviewed looking for the possible causes of the posterior capsule rupture made by the femtosecond laser.


The programmed posterior untreated zone was 0.5 mm or lower in all eyes. Four eyes were operated without direct OCT control of the procedure. In these eyes some eye movement after docking was detected, leading to eye tilt with further reduction of the untreated zone. Two eyes were operated with swept-source OCT control of the procedure. Direct laser cut of the posterior capsule was observed in one eye because of inaccurate programming, and capsule explosion associated with high energy was observed in the second eye with dense cataract because of the volume increment induced by gas bubbles


Two mechanisms for posterior capsule rupture during femtosecond laser fragmentation of cataracts were identified, both associated with the planning of excessively thin posterior untreated zone. Direct cut of the posterior capsule may be the result of improper programming, or of eye tilting during the procedure that remains undetected if the laser has no intra-operative real-time OCT. Capsule explosion may take place when using high energy close to the posterior capsule, because of the sudden pressure exerted towards the vitreous by the gas bubbles that develop, a mechanism similar to that of excessive hydrodissection.

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