gms | German Medical Science

27th International Congress of German Ophthalmic Surgeons

15. to 17.05.2014, Nürnberg

Refractive result prosecution: Refractive results are not better

Meeting Abstract

Search Medline for

  • Ulrich Mester - Augenzentrum im Medizeum, Saarbrücken

27. Internationaler Kongress der Deutschen Ophthalmochirurgen. Nürnberg, 15.-17.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocH 6c.24

doi: 10.3205/14doc024, urn:nbn:de:0183-14doc0245

Published: May 5, 2014

© 2014 Mester.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Particularly with aspheric, toric, and multifocal IOLs, perfect positioning of the artificial lens is mandatory to provide optimal visual performance.

It is therefore postulated that, using the femtosecond laser for capsulorhexis, a more precise capsulotomy with 360° IOL-capsular overlap can be achieved, leading to less IOL tilt and decentration.

I want to present some considerations which do not support these arguments:

  • Comparing eyes demonstrating a capsulorhexis which is too small, too large, or excentric to a control group with perfect capsulorhexes (635 consecutive surgeries) Findl found no difference in IOL tilt or decentration. In conclusion: With modern IOL designs, good postoperative capsular bag positioning appears to be relatively independent of shape and size of the capsulorhexis’ opening.
  • Using a different pupillometer we were able to show that, independent from capsulorhexis size and centration, the amount of IOL tilt and decentration was below a critical point causing visual impairment. Furthermore, the slight tilt and decentration was very similar to the position of the crystalline lens in a control group of young healthy individuals.
  • Is capsulorhexis really the dominant criterion for postoperative capsular shrinkage? What roles play LECs?
  • Based on the current literature, it remains uncertain, whether the laser capsular opening, resembling a micro- can opener technique bearing some risk for radial tears, is superior to a manually performed continuous capsulorhexis.

The laser may offer some advantages for the unexperienced surgeon. But does that justify the additional time, complexity, and costs (not at least for our patients) of this new technology for all of us?