Primary Posterior Laser-Assisted Capsulotomy

PURPOSE: To describe new techniques for performing primary posterior laser-assisted capsulotomy (PLC) to prevent posterior capsule opacification after cataract surgery. METHODS: After lens and cortex removal, three different techniques were used to cut the posterior capsule with an image-guided (optical coherence tomography [OCT]) femtosecond laser. Technique 1: Prior to intra-ocular lens (IOL) implantation, the posterior capsule was carefully opened and elevated with ophthalmic viscosurgical device (OVD) whereas the anterior hyaloid surface remains intact. After sterile re-docking, the posterior capsule was cut and removed and followed by IOL implantation. Techniques 2 and 3: After IOL implantation, a thin layer of OVD was injected between the IOL optic and the posterior capsule. After sterile re-docking, Berger's space and the posterior capsule were identified using OCT and the capsule was cut by the laser. The posterior capsule is located close to the anterior hyaloid membrane in Technique 2 and the posterior capsule is located between the posterior optic surface of the IOL and the anterior hyaloid in Technique 3. RESULTS: Technique 1 was performed in 50 PLC cases. All capsulotomies were easy to remove and no complications were observed. Techniques 2 and 3 were performed in 53 of 55 PLC cases. In 45 of these cases (82%), the posterior capsule was localized with open space between the IOL and Berger's space. In all treated PLC cases, a 360° cut was successfully accomplished. CONCLUSION: The described techniques for PLC have the potential to prevent and solve posterior capsule opacification in routine cases.