Prospective comparison of apex-centered vs standard pupil-centered femtosecond laser-assisted capsulotomy in cataract surgery

Purpose: Since recently the Victus femtosecond-laser platform is able to center the capsulotomy on the lens apex in femtosecond-laser assisted cataract surgery (FLACS). Aim of the study was to compare the lens tilt after apex-centered capsulotomy with standard pupil-centered capsulotomy. Setting: Clinical practice. Design: Prospective, randomized, investigator-masked trial. Methods: This prospective, randomized, investigator masked study included 40 patients with age-related cataract scheduled for FLACS in both eyes. The main outcome was the tilt of the intraocular lens, measured with the IOL Master 700 (Zeiss). Results: The study enrolled 80 eyes of 40 patients. Mean distance from the center of the apex-centered capsulotomy to the pupil-centered capsulotomy was 175.8 ± 97.2 µm. The amount of IOL tilt was not significantly reduced with the novel technique (p>0.05). Tilt orientation was more stable in eyes treated with apex-centered capsulotomy. Conclusion: Centration of the capsulotomy on the lens apex in FLACS does not influence the amount of IOL tilt but the orientation stability. The clinical importance of this finding has to be further elucidated.