Capsulotomy enlargement after femtosecond laser treatment among cataract patients of different age groups: a retrospective case series

Purpose: Larger-than-planned capsulotomies can occur, yet their association with age and eye parameters remains poorly understood. This study aimed to assess capsulotomy enlargement after femtosecond laser treatment in cataract surgery and to explore a possible correlation of capsulotomy enlargement with age and eye parameters. Methods: This retrospective case series included consecutive patients diagnosed with cataracts between 05/2018 and 11/2019. Among them, patients within the age ranges of <18, 18-49, and >= 50 years were assigned to the childhood cataract (CC), young adult cataract (YAC), and age-related cataract (ARC) groups, respectively. The capsulotomy enlargement ratio (CER), age, degree of cataract, lens thickness (LT), axial length, and anterior chamber depth were recorded and analyzed. Results: A total of 155 participants (179 eyes) were enrolled. The CER was significantly different among the three groups (CC: 1.245 vs. YAC: 1.060 vs. ARC: 1.029, P<0.001). The CER was found to be independently associated with both age (beta=-0.011 (0.001), P<0.001) and LT (beta=-0.049 (0.017), P=0.006) in the CC group, but it was only independently correlated with age (beta=-0.004 (0.001), P=0.002) in the YAC group and LT (beta=-0.014 (0.007), P=0.048) in the ARC group. Conclusions: Capsulotomy enlargement can occur after femtosecond laser treatment in cataract surgery, especially in the non-adult group. Age was a determinant of the CER in CC and YAC groups, while LT was an independent determinant of the CER in CC and ARC groups. These two factors should be taken into consideration for more precise sized capsulotomy.