Precision Pulse Capsulotomy: Performance Metrics and Utility in Routine and Complex Cases.

PURPOSE To evaluate precision pulse capsulotomy (PPC) performance. SETTING University and private practice in the United States and South Korea. DESIGN Multicenter retrospective analysis. METHODS Retrospective study of 337 cataract surgeries with PPC capsulotomy performed by 4 surgeons at 4 centers. Surgical videos were used to assess capsulotomy outcomes including completion rate, diameter, roundness (ovality), and quality of capsular overlap. RESULTS PPC use resulted in 99.4% free-floating capsulotomies from 337 cases. Video image analysis in a subset (n=52) yielded a mean capsulotomy diameter of 5.0mm +/- 0.16mm (SD) (95% CI 4.96-5.04 mm). Capsulotomies were round to slightly oval at the end of the case with an average ovality of 3.0% +/- 2.86% (SD) (95% CI 2.22%-3.78%). 360 capsular overlap was obtained in 98% of cases. The offset of the capsulotomy center with the IOL optic center was 197μm +/- 122μm (SD) (95% CI 148-246μm). PPC was used successfully in traumatic cataracts with compromised anterior and posterior capsule, phacodonesis, intumescent cataract with constricted pupil, and zonular dialysis, and in penetrating keratoplasty with open-sky extracapsular cataract extraction. CONCLUSIONS Surgeons obtained good PPC capsulotomy outcomes in routine and challenging cases. Little variation was observed in achieving free-floating capsulotomies with ∼5.0 mm diameter and complete capsular overlap. Variation was observed in the amount of offset between the capsulotomy center and the center of the IOL optic. PPC was useful in cases with multiple co-morbidities that challenge capsulotomy performance.