PMC6489659_01
Preoperative anterior segment optical coherent tomography image in both eyes. There was no significant tilt or decentration of the lens in either of the eyes (red box).
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Tilt and decentration measured by AS-OCT were 1.8  and 0.17 mm in the right eye and 0.2  and 0.11 in the left eye, respectively (Figure 2A and B).
Images from a circle scan (A) and a line scan (B) in the right eye. The circle scan indicated zonular dehiscence from 100  to 300 . The line scan showed that the largest area of zonular dehiscence was 210  (blue arrow).
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This pattern indicates zonular weakness or dialysis, and extends from 100  to 300  (Figure 3A). The line scan in the LenSx demonstrated the largest point of zonular weakness or dialysis, which was 210  in this case (Figure 3B). The circle and line scans revealed approximately 200  zonular weakness in total from 100  to 300 ; the largest point was 210 .
Intraoperative image in the right eye taken during femtosecond laser surgery showing a continuous curvilinear capsulorhexis, 5.0 mm in diameter, centered on White to White (yellow arrow). Nuclear fragmentation was achieved using the chop mode (blue arrow).
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A 5.0 mm capsulotomy centered on White to White (WTW) was created with 8.0 mJ of energy (spot and layer separations: 9 microm each) (Figure 4). Nuclear fragmentation was performed using the chop technique with 8.0 mJ of energy (spot and layer separations: 9 microm each) (Figure 4).
Image of the zonular dehiscence area from 100  to 300  (yellow shadow area).
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However, when the manual part of the operation was commenced, we observed zonular dialysis in the same area as seen on LenSx AS-OCT (Figure 5).
Image of circle scan (A) and line scan (B) in the left eye. The circle scan indicated zonular dehiscence from 90  to 270  (yellow shadow area). The line scan showed the largest area of zonular dehiscence was 180  (blue arrow).
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Again, this indicated zolular weakness or dialysis, and extended from 90  to 270  (Figure 6A). A line scan in the LenSx demonstrated the largest point of zonular weakness or dialysis, which was 270  in this case (Figure 6B).
Intraoperative image in the left eye taken during femtosecond laser surgery showing a continuous curvilinear capsulorhexis, 5.0 mm in diameter, centered on White to White (yellow arrow). Nuclear fragmentation was successfully achieved using the chop mode (blue arrow).
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A 5.0 mm capsulotomy, centered on WTW, was created with 8.0 mJ of energy (spot and layer separations: 9 microm each) (Figure 7). Nuclear fragmentation was performed using the chop technique with 8.0 mJ of energy (spot and layer separations: 9 microm each) (Figure 7).
Image of the zonular dehiscence area from 90  to 270  (yellow shadow area).
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Soon after the manual aspect of the operation was commenced, we observed zonular dialysis in the same area as shown by LenSx AS-OCT (Figure 8).
Image of optic capture involving the three-piece intraocular lens. The edge of the continuous curvilinear capsulorhexis is indicated by the yellow arrows.
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Image of anterior segment optical coherent tomography  in the left eye one month after the operation. There was no significant tilt and decentration in the intraocular lens with optic capture (red box).
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One month post-operatively, CASIA2 AS-OCT demonstrated that there was no significant tilt and decentration in the IOL with optic capture in the left eye (Figure 10).