Anterior lens capsule management in pediatric cataract surgery

Trans Am Ophthalmol Soc. 2004;102:391-422.


Purpose: To describe and analyze pediatric anterior capsulotomy techniques and make recommendations.

Methods: Five anterior capsulotomy techniques were compared using a porcine model. Extensibility was measured by calculating the mean stretch-to-rupture circumference of each capsulotomy (20 eyes per technique) as a percentage of its circumference at rest. Edge characteristics were reviewed using scanning electron microscopy. A 10-year review of consecutive pediatric cataract surgeries performed by the author focused on the anterior capsulotomy results. A worldwide survey was used to determine current practice patterns.

Results: Manual continuous curvilinear capsulorrhexis (CCC) produced the most extensible porcine capsulotomy (185%) with the most regular edge and is preferred by surgeons for patients aged 2 years and older. In the pseudophakic clinical cases reviewed, a radial tear developed in 3 (6.5%) of 46 manual CCC cases. Vitrectorhexis (porcine extensibility, 161%) is preferred by surgeons during the first 2 years of life. A radial tear developed in 16 (7.7%) of 208 vitrectorhexis pseudophakic eyes (29 tears in 284 pseudophakic eyes [10.2%] overall). The Kloti diathermy unit, Fugo plasma blade, and "can-opener" technique produced porcine capsulotomies of 145%, 170%, and 149% extensibility, respectively, and radial tears numbering 4 (21%) of 19, 5 of 8, and 1 of 2, respectively, in the clinical series.

Conclusions: All five capsulotomy techniques are recommendable for children. Only the vitrectorhexis and manual CCC are commonly used today. Vitrectorhexis is well suited for use in infants and young children; manual CCC is best used beyond infancy, and it produces the most stable edge.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Animals
  • Capsulorhexis / adverse effects
  • Cataract Extraction / methods*
  • Child
  • Child, Preschool
  • Humans
  • Infant, Newborn
  • Lens Capsule, Crystalline / surgery*
  • Models, Animal
  • Ophthalmologic Surgical Procedures / adverse effects
  • Ophthalmologic Surgical Procedures / instrumentation
  • Ophthalmologic Surgical Procedures / methods*
  • Retrospective Studies
  • Swine