Comparative Evaluation of Selective Laser Capsulotomy and Femtosecond Laser–Assisted Capsulotomy in White Cataract

Purpose: To evaluate morphological characteristics of capsulotomy created using selective laser capsulotomy (SLC) (CAPSULaser device; Excel-Lens, Inc) or femtosecond laser (FSL) (LenSx; Alcon Laboratories, Inc) in white cataract. Methods: This was a prospective non-randomized comparative study of 40 patients with white cataract who had phacoemulsification. A 5-mm capsulotomy was planned using SLC (n = 20) or FSL (n = 20). The primary outcome measure was capsulotomy size. Secondary outcomes were capsulotomy circularity, intraocular lens (IOL) coverage, centration, continuity, and residual microadhesions. Follow-up was performed on postoperative days 1 and 30. Results: The mean age of the patients was 65.3 ± 8.8 years (18 men, 22 women). Residual microadhesions were observed in 2 eyes (10%) in the SLC group and 11 eyes (55%) in the FSL group ( P = .002). Release of milky fluid did not obscure laser delivery in the SLC group, but hampered laser delivery in the FSL group. On postoperative day 1, mean capsulotomy diameter was 4.45 ± 0.17 mm in the SLC group and 5.03 ± 0.07 mm in the FSL group ( P < .001). Circularity index was comparable (SLC group: 0.993 ± 0.01, FSL group: 0.996 ± 0.005; P = .25), with 360° IOL coverage in both groups. Overlap index was 0.66 ± 0.27 in the SLC group and 0.84 ± 0.11 in the FSL group ( P = .01). Decentration was significantly greater with SLC (SLC group: 0.37 ± 0.37 mm, FSL group: 0.09 ± 0.07 mm; P = .004). No case had radial tear of capsulotomy or posterior capsule rent. Conclusions: Both FSL and SLC are safe and effective to create circular continuous capsulotomies in white cataract. FSL capsulotomies are more predictable in terms of size and centration. SLC capsulotomies have fewer microadhesions because fast capsulotomy creation does not allow milky cortex to obscure laser delivery.