Surgical Technique
One experienced surgeon (R.S.) performed all the surgeries. Capsulotomy, corneal incisions and lens fragmentation were accomplished by femtosecond laser (LDV Z8, Ziemer, Switzerland), followed by emulsification, irrigation and aspiration of lens material performed with the phacoemulsification machine (Centurion Vision, Alcon Laboratories, USA).
Capsulotomy was centered on the pupil center (PC) or the first Purkinje reflex (FPR), according to the protocol’s randomized assignment. For this matter, in the FPR group of patients, the coaxially sighted subject-fixated corneal light reflex (CSFCLR) was marked on the cornea surface with an ink marker, immediately before femtosecond docking, and capsulotomy was centered on this point. In the PC group, pupil centration was achieved automatically with LDV OCT imaging upon docking and capsulotomy performed henceforth (Figure 2A and B).