Prospective Case Series of Low-Energy Femtosecond Laser-Assisted Cataract Surgery in Pediatric Patients

Background: /Objectives: We report a consecutive prospective case series to obtain prospective safety and performance data of a low-energy femtosecond (FS)-laser for cataract surgery in children and to evaluate the applicability of the Bochum formula for capsulotomy diameter calculation. Methods: In pediatric lens surgery with implantation of a bag-in-the-lens intraocular lens (BIL IOL), anterior capsulotomies were performed using the FS-laser. Regression analysis was used to develop an age-dependent correction formula. Pearson correlation was used to evaluate applicability of the Bochum formula. Surgery related and ocular adverse events (AE) were recorded at 1 day, 1 week, 1 month, and 6 months postoperatively. Results: Thirteen eyes of 10 patients were included in analysis, among them 3 cases of subluxated lenses. The mean (SD) age was 3.10 ± 2.38 years (range: 4 months to 8 years). The linear bivalent regression yielded following formula: 1.27 – 0.014 x patient age. Age-related formulas such as the Bochum formula are required to calculate the programmed capsulotomy diameter. No complications related to the FS-laser or ocular AEs were observed up to six months; in particular no excessive shrinkage, retinal detachment or unusual inflammation were identified. Conclusions: This study indicates that the use of the low-energy femtosecond laser for anterior capsulotomy in pediatric lens surgery is safe and contributes to improved reliability and feasibility. The confirmed age dependence of the enlargement factor of the capsulotomy diameter might be related to the higher capsular elasticity in pediatric eyes.