Capsulotomy Morphology in Cataract Surgery - Comparison of Five Femtosecond Lasers

Sep 30, 2026

Uploaded by Angel

Experimental study comparing capsulotomy rim morphology from five femtosecond laser–assisted cataract surgery (FLACS) platforms: Catalys, FEMTO LDV Z8, LensAR, LenSx, and Victus. Anterior lens capsules from six interventions per platform (N=30) were evaluated using light microscopy and scanning electron microscopy, combining qualitative assessment with semiquantitative analysis of irregularities. Irregularities were present in all samples, but smoothness differed significantly, with Victus showing higher regularity than Catalys. Findings indicate platform-dependent morphology that may affect capsulotomy strength, with laser precision likely more important than pulse energy for surface regularity.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

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Purpose

Methods

Sample collection and imaging

Irregularity assessment

Results

Conclusions

74 LABORATORY SCIENCE Capsulotomy morphology in cataract surgery: comparison of five femtosecond lasers Isabel A. Joia, MD, Jonas M. Dürmüller, MD, Willi Halfter, PhD, Carsten H. Meyer, MD, PhD, Paul Bernhard Henrich, MD, PhD Purpose: To compare the capsulotomy rim morphology of anterior lens capsules obtained by 5 femtosecond laser–assisted cataract surgery (FLACS) platforms: Catalys, FEMTO LDV Z8, LensAR, LenSx, and Victus. Setting: University of Basel, Basel, Switzerland. Design: Experimental study. Methods: Anterior lens capsules from 6 interventions per laser platform were collected (N = 30) . 4 of each were assessed under light microscopy (LM; n = 20), and 2 were assessed under scanning electron microscopy (n = 10) . A qualitative evaluation of all samples was conducted, as well as a semiquantitative analysis of the extent of irregularities present in LM samples. The Dunn multiple comparisons test was conducted to determine which lasers produced significantly smoother capsulotomies. Results: Irregularities along the lens capsule rim were observed in all samples. Distinct irregularities were observed for Catalys (unconnected laser pulses bordering the capsulotomy), FEMTOLDV Z8 (numerous additional rows of laser pulses), and LensAR (at least one section with multiple rows of laser pulses) . Victus demonstrated a significantly higher degree of smoothness of capsulotomy (median = 306 degrees) compared with Catalys (median = 171 degrees) (P = .02) . The medians for other laser platforms fell between these values. Conclusions: Different laser platforms produce morphologically and quantitatively distinct irregularities, which may influence capsulotomy strength differently. FEMTO LDV Z8, a lowenergy laser, did not produce a smoother capsulotomy than the high-energy lasers . Our results suggest that, with current technologies, the precision of the laser is more important than the pulse energy in determining the regularity of the capsulotomy surface . J Cataract Refract Surg 2026; 52:74–80 Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of ASCRS andESCRS Cataract surgery is one of the most frequently per formed surgeries, with an estimated over 7 million yearly interventions in the United States and the European Union combined. 1,2 The introduction of femtosecond laser–assisted cataract surgery (FLACS) over a decade ago presents an important advancement in surgical techniques for cataract treatment.3 This procedure is characterized by the use of a laser to perform capsulotomy compared with a fine needle or forceps during conventionalphacoemulsification cataract surgery (CPCS) (Figure 1, A – D) .4 This difference in technique results in distinct effects on the shape and morphology of the capsulotomy. On a macroscopic level, FLACS capsulotomies are positioned more accurately and are rounder in shape compared with CPCS capsulotomies, leading to a better centration of the intraocular lens in the capsular bag (compare Figure 1, A and C) .5–8 However, on a microscopic level, FLACS capsulotomy rims are irregular, characterized by tags, aberrant laser pulses, indentations, and notches.9,10 By contrast, CPCS capsulotomy rims are smooth and homogeneous (compare Figure 1, B and D) .11 The microscopic irregularities seen in FLACS capsulotomies may influence surgical outcomes. For instance, discontinuous laser pulses could result in an incomplete separation of the created flap from the anterior lens capsule.12 In addition, the irregularities lead to an uneven stress distribution along the capsulotomy’s circumference with focal points of high mechanical stress, which weaken the Submitted: April 3, 2025 | Final revision submitted: August 3, 2025 | Accepted: August 4, 2025 From the University of Basel, Basel, Switzerland (Joia); Universita` della Svizzera Italiana, Lugano, Switzerland (Dürmüller, Henrich); Department of Ophthalmology, University of Basel, Basel, Switzerland

FAQs

What was the purpose of this study?

The study compared capsulotomy rim morphology produced by five FLACS platforms.

How were the lens capsules evaluated?

Anterior lens capsules from each platform were assessed using light microscopy and scanning electron microscopy, with qualitative review and semiquantitative analysis of irregularities.

Which laser platform produced the smoothest capsulotomy edges?

Victus demonstrated significantly higher smoothness compared with Catalys, while other platforms had median values between these extremes.

Sep 30, 2026

Uploaded by Angel