Purpose: To evaluate precision pulse capsulotomy (PPC) in simple and challenging cataract surgery cases.

Setting: Clínica Quesada, San Salvador, El Salvador.

Design: Prospective case series.

Methods: This single-center prospective study assessed cataract surgeries with anterior capsulotomy performed using a PPC device through a 2.2 mm corneal incision in the presence of an ophthalmic viscosurgical device. This was followed by phacoemulsification and intraocular lens implantation. Outcomes included capsulotomy appearance and diameter, surgical complications, and postoperative visual acuity.

Results: The study comprised 38 eyes. All cases resulted in 360-degree complete, round capsulotomies averaging 5.5 mm in diameter with intracapsular IOL fixation. No PPC-related complications were observed intraoperatively or on follow-up at 3 to 8 months. The PPC was useful in challenging cases with corneal opacities that obscured the capsulotomy path or with poorly dilated pupils. Precision pulse capsulotomy occurs instantaneously everywhere along the capsulotomy path, which allowed safe release of subcapsular pressure in intumescent cataracts with consistent creation of a round, appropriately sized capsulotomy. The PPC edge quality was shown in a case with 6 clock hours of zonular dialysis in which iris hooks held the capsulotomy edge for over 45 minutes for removal of a 4+ cataract.

Conclusions: Precision pulse capsulotomy had a short learning curve and was integrated seamlessly into the surgical routine. The combination of suction with ultrafast capsulotomy provided capsulotomy roundness, sizing, safety, and edge quality that significantly facilitated difficult cases. The ease of use, consistency, and efficiency of PPC capsulotomy might support its use under many practice scenarios.