Efficacy of femtosecond laser for anterior capsulotomy in complex white cataracts

Objective: To determine the advantages and complication rate of capsulotomy performed with femtosecond laser in white complex cataract cases. Study design: Retrospective case series. Participants: Sixteen eyes of 16 patients. Methods: This was a single-center retrospective review of white cataract surgery cases in which the femtosecond laser (LenSx, Alcon Laboratories, Fortworth, Texas, USA) was used between May 2019 and February 2021. Outcome measures included an assessment of the capsulotomy, identification of tags, surgical time, cumulative dispersed energy (CDE) and postoperative management. Results: Sixteen eyes of 16 patients were included in this study; capsule tags occurred in six patients (37.5%). In 2 patients, the capsule presented small adhesions that were identified and removed. One patient presented a very significant contraction of the anterior capsule with an incomplete cut zone of 2 to 4 hours. In a patient with nystagmus, the capsulotomy was performed without complications under peribulbar anesthesia. Conclusions: The femtosecond laser permitted capsulotomies of better shape, size and regularity in complex cases of white cataract and in combination with conditions such as nystagmus and prior corneal transplantation. The microadhesions and untreated areas were identified with trypan blue, which is essential to use in these cases to avoid associated complications.