title: Precision Pulse Capsulotomy: Preclinical Safety and Performance of a New Capsulotomy Technology.
abstract: OBJECTIVE
  To assess the preclinical safety and performance of a new precision pulse capsulotomy (PPC) method.
  
  
  METHODS
  Human cadaver eye studies and surgical, slit-lamp, and histopathologic evaluation in a consecutive series of 20 live rabbits.
  
  
  METHODS
  Human cadaver eyes and New Zealand white rabbits.
  
  
  METHODS
  Precision pulse capsulotomy uses a highly focused, fast, multipulse, low-energy discharge to produce a perfectly round anterior capsulotomy instantaneously and simultaneously along all 360°. Capsulotomies are performed using a disposable handpiece with a soft collapsible tip and circular nitinol cutting element. Miyake-Apple imaging and scanning electron microscopy (SEM) of PPC were conducted in human cadaver eyes. Surgical, postoperative slit-lamp, and histopathologic assessments of PPC were performed in 20 live rabbits and were compared with manual continuous curvilinear capsulorrhexis (CCC) in the fellow eye. Anterior chamber (AC) thermocouple temperature measurements were evaluated in a subset of rabbit eyes.
  
  
  METHODS
  Capsulotomy edge circularity, SEM morphologic features and zonular movement with PPC in human cadaver eyes. Anterior chamber temperature during PPC and grading of ocular inflammation, corneal endothelial damage, anterior capsular opacification (ACO), and posterior capsular opacification (PCO).
  
  
  RESULTS
  Miyake-Apple imaging showed minimal zonular stress, and thermocouple measurements demonstrated negligible AC temperature changes during PPC. Precision pulse capsulotomy produced round, complete capsulotomies in all 20 rabbit eyes, leading to successful in-the-bag intraocular lens (IOL) implantation. Slit-lamp examinations at 3 days and 1, 2, and 4 weeks after surgery showed no significant differences between PPC and CCC in corneal edema, AC inflammatory reaction, capsular fibrosis, ACO, and PCO. Postmortem studies showed no difference in the corneal endothelium between PPC and CCC eyes. All IOLs were well centered in PPC eyes, and histopathologic analysis showed no greater inflammatory infiltrates.
  
  
  CONCLUSIONS
  Precision pulse capsulotomy is a new method to automate consistent creation of a perfectly circular anterior capsulotomy with a disposable handheld instrument that can be used in the normal phacoemulsification surgical sequence. Compared with CCC in fellow rabbit eyes, PPC was equally safe and showed no greater zonular stress compared with CCC in human cadaver eyes. Human cadaver eye SEM showed a much smoother capsulotomy edge compared to those produced by femtosecond laser.
authors.affiliation: Altos Eye Physicians, Los Altos, California. Electronic address: dceye@earthlink.net.
authors.forename: David F
authors.initials: DF
authors.lastname: Chang
authors.affiliation: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
authors.forename: Nick
authors.initials: N
authors.lastname: Mamalis
authors.affiliation: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.
authors.forename: Liliana
authors.initials: L
authors.lastname: Werner
mesh_terms: D000818:Animals; D057866:Anterior Capsule of the Lens / Q000601:surgery* / Q000648:ultrastructure; D001831:Body Temperature; D058442:Capsule Opacification / Q000175:diagnosis; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods*; D019654:Lens Implantation, Intraocular; D008022:Ligaments / Q000648:ultrastructure; D008855:Microscopy, Electron, Scanning; D018918:Phacoemulsification; D011817:Rabbits