title: Induced inflammation and apoptosis in femtosecond laser-assisted capsulotomies and manual capsulorhexes: an immunohistochemical study.
abstract: OBJECTIVE
  To evaluate cellular inflammation and apoptosis induced in the central portion of capsulorhexes/capsulotomies during cataract surgery, comparing a conventional manual technique and a femtosecond laser-assisted procedure at different energy settings using two laser systems.
  
  
  METHODS
  Fifty-six capsulorhexes/capsulotomies were divided into four groups: the manual group (14 capsulorhexes) performed with the manual technique; the 7.0-µJ group (14 capsulotomies) (LensAR laser system; Lensar, Inc., Orlando, FL); the 10-µJ group (14 capsulotomies) (LenSx laser system; Alcon Laboratories, Inc., Fort Worth, TX); and the 13.0-µJ group (14 capsulotomies) (LenSx laser system). All samples were stained for cellular apoptosis analysis (TUNEL assay) and cellular induced inflammation (NF-κB).
  
  
  RESULTS
  One-way analysis of variance indicated a statistically significant difference in the percentage of NF-κB and TUNEL positive cells between the four groups, (F [3.52] = 14.717, P < .001) and (F [3.52] = 139.561, P < .001), respectively. Post-hoc analysis indicated a statistically significant difference in the percentage of NF-κB positive cells between the 13.0-µJ group and the manual, 7.0-µJ, and 10-µJ groups (P < .001, = .037, and < .001, respectively). Post-hoc analysis of differences in TUNEL positive cells indicated a significant difference between the 7.0-µJ and 10-µJ groups (P <.017) and between the 13.0-µJ group and the manual, 7.0-µJ, and 10-µJ groups (P < .001, < .001, and < .001, respectively).
  
  
  CONCLUSIONS
  The results show a higher percentage of NF-κB and TUNEL positive cells in the 13.0-µJ group compared to the 7.0-µJ, 10-µJ, and manual groups. Therefore, inflammatory response and cell death increased at increasing energies. An effective capsulotomy in femtosecond laser-assisted cataract surgery with minimal detrimental apoptotic and inflammatory effects is possible if the laser system is set to use the minimum energy level.
authors.forename: Lisa
authors.initials: L
authors.lastname: Toto
authors.forename: Roberta
authors.initials: R
authors.lastname: Calienno
authors.forename: Claudia
authors.initials: C
authors.lastname: Curcio
authors.forename: Peter A
authors.initials: PA
authors.lastname: Mattei
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mastropasqua
authors.forename: Manuela
authors.initials: M
authors.lastname: Lanzini
authors.forename: Leonardo
authors.initials: L
authors.lastname: Mastropasqua
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017209:Apoptosis; D019923:Capsulorhexis / Q000379:methods*; D004847:Epithelial Cells / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D020287:In Situ Nick-End Labeling; D007903:Lens Capsule, Crystalline / Q000378:metabolism / Q000473:pathology*; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D016328:NF-kappa B / Q000378:metabolism; D018918:Phacoemulsification; D064727:Posterior Capsulotomy / Q000379:methods*; D016037:Single-Blind Method; D014606:Uveitis, Anterior / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism
chemical_list: D016328:NF-kappa B