Greater vertical spot spacing to improve femtosecond laser capsulotomy quality

Purpose: To evaluate the effect of adapted capsulotomy laser settings on the cutting quality in femtosecond laser-assisted cataract surgery.

Setting: Ruhr-University Eye Clinic, Bochum, Germany.

Design: Prospective randomized case series.

Methods: Eyes were treated with 1 of 2 laser settings. In Group 1, the regular standard settings were used (incisional depth 600 μm, pulse energy 4 μJ, horizontal spot spacing 5 μm, vertical spot spacing 10 μm, treatment time 1.2 seconds). In Group 2, vertical spot spacing was increased to 15 μm and the treatment time was 1.0 seconds. Light microscopy was used to evaluate the cut quality of the capsule edge. The size and number of tags (misplaced laser spots, which form a second cut of the capsule with high tear risk) were evaluated in a blinded manner. Groups were compared using the Mann-Whitney U test.

Results: The study comprised 100 eyes (50 eyes in each group). Cataract surgery was successfully completed in all eyes, and no anterior capsule tear occurred during the treatment. Histologically, significant fewer tags were observed with the new capsulotomy laser setting. The mean score for the number and size of free tags was significantly lower in this group than with the standard settings (P < .001).

Conclusions: The new laser settings improved cut quality and reduced the number of tags. The modification has the potential to reduce the risk for radial capsule tears in femtosecond laser-assisted cataract surgery. With the new settings, no tags and no capsule tears were observed under the operating microscope in any eye.