Visualization And Expansion Of Berger Space Through Transzonular Capsulo-Hyaloidal Hydroseparation In Femtosecond Laser-Assisted Cataract Surgery

Primary posterior capsulotomy (PPLC) has proven to be effective in preventing posterior capsule opacification (PCO). Key to PPLC is visualizing Berger's Space (BS), achievable via transzonular capsulo-hyaloidal hydroseparation.

This study assesses PPLC suitability in age-related cataracts and BS expansion after hydroseparation.

In this prospective study we included 180 eyes from 96 patients with age-related cataract suitable for PPLC at the Medical University of Vienna.

Primary study outcomes include the classification of BS into 3 categories:

A: Complete attachment of AHM to PC

B: Partial attachment of AHM to PC

C: No attachment of AHM to PC

Categories A-C are evaluated using intraoperative visualization of integrated OCTs of the femtosecond laser (LDV-Z8), first natively, second after hydroseparation (with BSS), and third after a second hydroseparation (with triamcinolone).

Our study evaluated BS expansion across three stages. Initially, 45% of eyes exhibited AHM to PC detachment, with 40% completely detached. After the first hydroseparation, detachment cases increased to 58%, with complete detachment in 59% of instances. After the second hydroseparation using Triamcinolone, complete detachment rose to 67% while overall detachment reached 64%.

Transzonular capsulo-hyaloidal hydroseparation efficiently creates a complete and secure Berger Space for PPLC with complete detachment rates improving from 18% to 43%. Triamcinolone crystals enhance AHM visibility in OCT imaging though caution is advised due to potential clouding.