Femtosecond Laser–Assisted Cataract Surgery In Pediatric Patients, A Prospective Case Series

To examine the safety of using the FEMTO LDV Z8 Femtosecond Surgical Laser (Ziemer Ophthalmic Systems, AG) for creation of an anterior capsulotomy in a pediatric population. As a secondary objective, we assessed the achieved diameter versus the aimed diameter of the anterior capsulotomy.

Monocentric prospective trial in a tertiary hospital, Antwerp University and University Hospital Antwerp, Belgium

A prospective observational study was set up. All children under 18 years old who were scheduled for surgical cataract repair of one or both eyes were eligible to participate. Surgery related adverse events at the time of surgery and ophthalmic adverse events at 1 day, 1 week, 1 month, 6 months were recorded. Preoperative mydriatics were administered. Aimed capsulotomy diameter was calculated following the Bochum formula. After docking to the femtosecond laser device (FEMTO LDV Z8 Femtosecond Laser, Ziemer Ophthalmic Systems AG) an anterior laser capsulotomy was performed. The achieved capsulotoy size was measured on video footage, based on the size of a ring calliper used at the time of the surgery.

Out of the 17 children, only 10 were eligible for the study based on the  size of the eyelid aperture allowing adequate docking. Of these 10 children, 3 underwent femtosecond capsulotomy in both eyes, coming up to a total of 13 eyes where we performed the femtosecond anterior capsulotomy. We included the following types of childhood cataract: anterior capsular/epinuclear; lamellar, AVLID, PFV and subluxated lenses. Limited subconjunctival haemorraghes occurred in almost all eyes as well as 2 tears of the anterior capsule when positioning the BIL implant. However, this did not impair the stability of the IOL in the eye. We have not seen any postoperative complications related to the capsulotomy during 6 months of follow-up.

When docking is possible, anterior capsulotomy of the correct diameter could  be safely done using the Femto LDV Z8 laser. Developing a smaller suction cup could enable performing the capsulotomy in the small eyes of newborns where docking was not possible due to the small eyelid aperture.