Joshua H. Hou, MD, Joao Crispim, MD, Maria S

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Image-guided femtosecond laser–assisted cataract surgery in Peters anomaly type 2 Joshua H. Hou, MD, Joao Crispim, MD, Maria S. Cortina, MD, Jose de la Cruz, MD Journal of Cataract & Refractive Surgery Volume 41, Issue 11, Pages 2353-2357 (November 2015) DOI: 10.1016/j.jcrs.2015.10.045 Copyright © 2015 ASCRS and ESCRS Terms and Conditions

Figure 1 Preoperative AS-OCT (A and B) and slitlamp photograph (C) of the left eye of the patient with Peters anomaly type 2. A broad corneolenticular adhesion (A and B) was noted in parallel slices, with evidence of potential traction on adjacent Descemet membrane (A, arrow) noted on an inferior slice. Journal of Cataract & Refractive Surgery 2015 41, 2353-2357DOI: (10.1016/j.jcrs.2015.10.045) Copyright © 2015 ASCRS and ESCRS Terms and Conditions

Figure 2 Intraoperative view of the left eye after docking on a femtosecond laser platform. A: Initial docking resulted in a large retained air bubble (white arrow) due to the small, steep cornea. B: After burping out the air by manipulating the eye under suction, only a small air bubble remains (yellow arrow). The capsulotomy is adjusted to avoid the central corneal scar, the inferonasal iridolenticular adhesion (asterisk), and residual air bubbles under the contact patient interface. Journal of Cataract & Refractive Surgery 2015 41, 2353-2357DOI: (10.1016/j.jcrs.2015.10.045) Copyright © 2015 ASCRS and ESCRS Terms and Conditions

Figure 3 Intraoperative AS-OCT of the left eye showing (A) a scrolled cross-sectional display along the intended circumference of the capsulotomy and (B) a single axial cross-section along the axis of greatest lens tilt. A: The height and position of the capsulotomy is adjusted to ensure that the anterior (white arrow) and posterior limits (gray arrow) of the laser cut contain the anterior capsule for the full 360-degree circumference of the capsulotomy. Due to multiple peaks (yellow arrowheads) and troughs (blue arrowheads) in the distorted anterior lens capsule, alignment of the anterior and posterior limits of the laser cut on a single peak or trough can result in an incomplete capsulotomy. B: On axial cross-section, care should be taken to ensure the intended path of the laser (demarcated by the purple lines) does not hit the cornea. Since the anterior chamber in Peters anomaly type 2 is deeper peripherally, smaller capsulotomies (yellow lines) are more likely to hit the cornea. Air bubbles (asterisk) between the cornea and the patient interface can cause shadowing. Journal of Cataract & Refractive Surgery 2015 41, 2353-2357DOI: (10.1016/j.jcrs.2015.10.045) Copyright © 2015 ASCRS and ESCRS Terms and Conditions

Figure 4 Intraoperative photograph of the left eye taken after trypan blue staining of the anterior capsular. Spontaneous separation and flattening of the peripheral capsule tissue from the central capsule tissue (which remains adherent to the cornea) after femtosecond laser capsulotomy results in a visible gap (arrows) and dilation of the initial capsulotomy diameter. Journal of Cataract & Refractive Surgery 2015 41, 2353-2357DOI: (10.1016/j.jcrs.2015.10.045) Copyright © 2015 ASCRS and ESCRS Terms and Conditions

Figure 5 Postoperative photograph (A) and AS-OCT (B) showing a central corneal scar with adherent remnants of the anterior capsule. Journal of Cataract & Refractive Surgery 2015 41, 2353-2357DOI: (10.1016/j.jcrs.2015.10.045) Copyright © 2015 ASCRS and ESCRS Terms and Conditions