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Capsulotomy or capsulorhexis in femtosecond laser–assisted cataract surgery?

Dick, Burkhard H. MD, PhD; Gerste, Ronald D. MD; Schultz, Tim MD; Waring, George O. III MD, FACS, FRCOphth

Journal of Cataract & Refractive Surgery: September 2013 - Volume 39 - Issue 9 - p 1442
doi: 10.1016/j.jcrs.2013.07.004
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Cataract surgery continuously advances—sometimes with subtle changes in technique, other times with paradigm-shifting new technology. Making a continuous circular opening in the anterior lens capsule prior to cataract removal exemplifies a subtle manual technique that makes the procedure more predictable and safe. The use of a femtosecond laser to make the anterior capsule opening and to divide the nucleus into smaller pieces involves a major technological shift.

The major advances also require a change in terminology. The modern manual anterior capsule opening is commonly designated continuous curvilinear capsulorhexis, abbreviated CCC by its progenitors Howard Gimbel and Thomas Neuhann1: “continuous” because when properly made, there are no nicks or tears in the edge of the opening, distinguishing it clearly from the multiple punctures of the previous can-opener technique; “curvilinear” describing the somewhat irregular asymmetric curvilinear contour, which may sometimes be a perfect circular configuration; “capsulorhexis” designating the tissue of interest, the lens capsule, and the surgical technique of tearing (neo-Latin/Greek: rhexis) by shearing or ripping with a forceps or a bent needle.

In contrast, the femtosecond laser, which works as a knife by focal photodisruption, creates a capsulotomy: The capsule is still the tissue manipulated, but in this case by cutting with the laser (Greek: tomos, to cut). The capsulotomy is intended to be continuous (as long as the femtosecond laser pulses overlap each other and make no tags or tears) and circular, which the laser achieves in almost every case, certainly more frequently than during manual curvilinear capsulorhexis.

The problem of accurate language usage arises when surgeons, out of habit, refer to the femtosecond opening as a capsulorhexis,2–4 an unintentional error because there is no tearing or shearing. Henceforth, let us make the term “femtosecond capsulotomy.”


1. Gimbel HV, Neuhann T. Development, advantages, and methods of the continuous circular capsulorhexis technique. J Cataract Refract Surg. 1990;16:31-37.
2. Nagy ZZ, Ecsedy M, Kovács I, Takács Á, Tátrai E, Somfai GM, Cabrera DeBuc DC. Macular morphology assessed by optical coherence tomography image segmentation after femtosecond laser-assisted and traditional cataract surgery. J Cataract Refract Surg. 2012;38:941-946.
3. Bali SJ, Hodge C, Chen S, Sutton G. Femtosecond laser assisted cataract surgery in phacovitrectomy. Graefes Arch Exp Ophthalmol. 2012;250:1549-1551.
4. Nagy ZZ, Filkorn T, Takács AI, Kránitz K, Juhasz T, Donnenfeld E, Knorz MC, Alio JL. Anterior segment OCT imaging after femtosecond laser cataract surgery. J Refract Surg. 2013;29:110-112.
© 2013 by Lippincott Williams & Wilkins, Inc.