Anterior And Posterior Femtolaser Capsulotomy In Congenital Cataract Surgery In Children

The femtolaser advantages makes it necessary for congenital cataract surgery in children. The increased extensibility and elasticity of the lens capsule in children complicates the manual capsulorexis and causes an increased risk of complications. The functional outcome depends on the accuracy of the anterior capsulorexis. In cases of the posterior capsule fibrosis, it becomes necessary a continuous circular posterior capsulorexis, that is difficult to perform manually. The purpose is to optimize the method and evaluate the results of anterior and posterior femtocapsulotomies in congenital cataracts surgery in children with use of femtolaser Femto LDV Z8 (Ziemer, Switzerland).

Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution.

18 patients (18 eyes) with congenital cataract with the posterior capsule opacification, in 10 cases - with primary persistent hyperplastic vitreous, 3 of them – with a visualized hyaloid artery. Age – from 4 months to 15 years 6 months. Concomitant ophthalmopathology: optic nerve atrophy, exotropia – 1, congenital microphthalmos – 1, myopic astigmatism – 1, cicatricial ROP – 2. BCVA in 8 patients older than 4 years before surgery was 0.25±0.06. Femtolaser assistance for anterior and posterior capsulotomy was performed by femtolaser Femto LDV Z8. To perform posterior femtocapsulotomy, the anterior chamber was filled with viscoelastic DisCoVisc so the posterior capsule located not lower than 1.0 mm from the iris, and not higher than it.

Anterior femtolaser capsulotomy was performed in 17 eyes (94.4%). In 1 case, docking could not be performed due to small eye size. Posterior femtolaser capsulotomy was performed in 13 eyes (76.5%). In 2 patients, the posterior capsule was transparent intraoperatively. 2 patients had a spontaneous posterior hole. Femtolaser power for anterior capsulotomy was 57.3±1.55%, the speed was 36.9±0.90 mm/s, for posterior one – 55.4±2.23% and 25.8±0.52 mm/s, respectively. The increase in the anterior femtocapsulotomy achieved diameter compared to the program one was 24.2%, in the posterior – 19.0%. 1 month after the operation, mean BCVA in children capable of its evaluation was 0.54±0.23.

The results demonstrate the possibility of successful application of modern femtolaser technologies in the surgery of congenital cataracts in children. The technique of posterior femtolaser capsulotomy was modified to ensure the optimal position of the posterior lens capsule for the correct femtolaser working. An increase in BCVA was achieved from 0.25±0.06 to 0.54±0.23 1 month after surgery, which creates favorable conditions for the further visual functions forming in children.