Use of the 590-nm CAPSULaser in true open-sky penetrating keratoplasty triple procedures: a technical report of two cases.

PURPOSE: To describe the technical feasibility of using a microscope-mounted 590 nm selective laser capsulotomy system (CAPSULaser) to create an anterior capsulotomy under true open-sky conditions during penetrating keratoplasty (PKP) triple procedures.

METHODS

This retrospective two-case technical report included two eyes with advanced corneal opacity and visually significant cataract. After removal of the host corneal button, trypan blue 0.06% staining and the microscope-mounted CAPSULaser were used to create a targeted 5.5 mm anterior capsulotomy. Intraoperative completion of the capsulotomy, capsular extension, vitreous loss, nucleus delivery, and intraocular lens (IOL) placement were recorded descriptively.

RESULTS

A continuous 360 degree capsular opening was obtained in both eyes with an active laser scan lasting less than 0.3 s. No radial capsular extension or vitreous loss was reported in either procedure. Extracapsular nucleus expression, cortical cleanup, and in-the-bag posterior chamber IOL implantation were completed in both eyes. At the 6-month examinations, the grafts were clear and the IOLs were centered; the available report does not support comparative or long-term outcome conclusions.

CONCLUSIONS

These two cases show that a 590 nm CAPSULaser capsulotomy can be performed after removal of the host cornea during a PKP triple procedure. The observations support technical feasibility only. They do not establish safety, efficacy, reproducibility, superiority to manual techniques, or a lower complication rate; larger prospective comparative studies with longer follow-up are required.