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Anterior capsule of the lens: morphological analysis and apoptosis evaluation following femtosecond laser-assisted cataract surgery

Poster Details

First Author: A.Pisciotta ITALY

Co Author(s):    T. Verdina   M. De Maria   E. Fornasari   A. de Pol   G. Cavallini        

Abstract Details


Comparative evaluation of the morphological features of the anterior capsule and apoptosis induction in lens epithelial cells (LEC) after femtosecond laser (FSL) assisted cataract surgery compared with standard phacoemulsification surgery.


Institute of Ophthalmology, University of Modena & Reggio Emilia, Modena, Italy (Head: Prof. Gian Maria Cavallini).


Observational study. Group A, 30 FSL anterior capsulotomies (diameter 5.2mm); Group B, 30 manual anterior continuous curvilinear capsulorhexis (diameter between 5.0 and 5.5 mm). All patients were operated by the same experienced surgeon with bimanual microincision cataract surgery without any intraoperative and post-operative complications. Anterior capsules obtained from both surgical approaches were processed to evaluate morphological features of LECs, the capsule edges and thickness, through light optical and scanning electron microscopy. Moreover, the expression of cleaved caspase 3 was investigated through immunofluorescence analysis to evaluate the apoptosis induction in LECs.


In both groups, the light microscopy and histological analysis showed the preservation of the capsular epithelium and a greater thickness for the capsules of the group A, without any statistically significant differences between the two groups. Scanning electron microscopy analysis revealed irregular sawtooth shaped edges with a postage-stamp appearance in capsules from group A; on the contrary, capsules from group B showed regular, continuous and smooth edges. Finally, immunofluorescence analysis demonstrated a statistically significant higher expression of the downstream apoptotic effector cleaved caspase 3 in group A, when compared with the expression levels in group B.


The greater capsular thickness of group A is due to the presence of cortex adherent to the anterior capsule. Moreover, the postage stamp appearance is most likely attributable to the progressive sequence of laser pulses on the capsule. The low energy and high frequency properties of the laser pulse, combined with a consequent overlapped pulse pattern, resulted in highly continuous morphology of capsule edges, in contrast with other data in the literature. The higher apoptotis induction in the FSL group might be due to higher inflammation levels caused by the formation of gas microplasma bubbles, according to the literature.

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