We describe a technique for preventing secondary membrane formation after pediatric cataract extraction. This technique involves capture of an intraocular lens (IOL) optic through a posterior curvilinear capsulorhexis opening in an attempt to maintain a clear visual axis in children after cataract surgery. This maneuver ensures centration of the posterior chamber IOL because the haptics remain in the capsular bag and the optic is captured in the posterior capsular opening. Also, the need for an anterior vitrectomy may be eliminated. Apposition of the anterior and posterior capsule leaflets anterior to the optic may limit the migration of Elschnig pearls, reducing the incidence of secondary membranes and the need for additional procedures.

A continuous curvilinear capsulorhexis (CCC) provides a tear-resistant opening that allows use of a technique of capturing the intraocular lens (IOL) optic through the capsulorhexis opening when the opening is at least 1.0 to 2.0 mm smaller than the optic diameter. The technique provides stability and long-term centration of the IOL and prevents vitreous from extending anterior to the IOL. This paper reviews the current variations of optic capture including (1) haptics in the sulcus and IOL optic capture through a CCC, (2) haptics in the sulcus and IOL optic capture through an anterior capsule opening and a posterior CCC (PCCC), (3) haptics in the capsular bag and IOL optic capture through a PCCC, (4) haptics in the capsular bag and IOL optic capture through an anterior CCC, (5) haptics in the sulcus and IOL capture through a capsular membrane opening, and (6) haptics posterior to the capsular bag and IOL capture through a capsular membrane opening.

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We investigated trabeculotomy ab externo as a means of optimizing intraocular pressure (IOP) control in glaucoma patients having phacoemulsification and implantation of an intraocular lens (IOL). A prospective, randomized, controlled study was performed to evaluate the effect on IOP and the incidence of complications associated with combined phacoemulsification and trabeculotomy ab externo. The study group had the combined procedure, while the control group had only phacoemulsification with IOL implantation. A total of 106 patients were randomized, and the IOP for each group was compared at 3, 6, 12, and 24 months. At two years, the mean IOP reduction was 6.1 mm Hg in the study group and 3.8 mm Hg in the control group (P = .001). There were no complications in the control group. Two complications (2/53 or 3.8%) occurred in the study group: a small tear in Descemet's membrane and a postoperative microhyphema. There was no increase in medication in either the study or control group. Combined phacoemulsification and trabeculotomy ab externo represents an option to lower IOP and potentially reduce the need for pressure-lowering medications in patients with primary open-angle glaucoma and visually significant cataracts.