Plasma Ablation Capsulotomy (PAC) is the future for cataract surgery. There are 2 types of PAC. Femtosecond laser capsulotomy and Fugo Plasma Blade Capsulotomy. Both technologies employ plasma to ablate a precise, strong opening in the anterior capsule. Femtosecond produces a smooth rim whereas the Fugo Blade creates a unique postage stamp capsulotomy which was discussed in the classic article by Apple et al in the orange journal (Vol 30) 2004. Therein Apple described the postage stamp capsulotomy as a highly desirable capsulotomy which he attempted to create with other technologies but was unsuccessful. The Fugo Plasma Blade creates a postage stamp capsulotomy automatically! The Fugo Plasma Blade also allows one to revise the capsulotomy in seconds, repair tears in the capsule in seconds as well as allowing a surgeon to perform the capsulotomy under the iris without surgeon visualization. There are also cost considerations. The Fugo Plasma Blade is a sub $20K investment whereas the femtosecond laser is extremely costly. Furthermore, the Fugo Plasma Blade now has 10 years of utilization in the USA with an impeccable safety record. There are several advantages to the femtolaser including their ability to create incisions in the cornea, however the safety and cost of these advantages are yet to be determined.
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