Comparison of mechanized anterior capsulectomy and manual continuous capsulorhexis in pediatric eyes

Abstract

Performing a continuous curvilinear capsulorhexis (CCC) can be more difficult in children than in adults because the capsular bag is more elastic. In this study we compared two capsulectomy techniques in pediatric eyes: creating a mechanized circular anterior capsulectomy using a vitrector and creating a conventional smooth-edged curvilinear tear or CCC using a forceps or needle. We used 18 pairs of eyes (36 eyes) obtained postmortem from children ranging in age from four days to 16 years. The mechanized vitrector-cut capsulectomy was unsuccessful in only one eye (from a 16-year-old child) in which a radial tear developed. Manual CCC was unsuccessful in six eyes, all from children less than five years of age. We conclude that mechanized circular capsulectomy is not only easier to perform in very young eyes than manual CCC, but it is also safe and creates a capsular opening that resists radial tearing. This mechanized technique gives the surgeon an alternative to use in pediatric eyes in which standard manual CCC may be difficult to perform and control.

Pediatric cataract extraction with intraocular lens implantation: Visual acuity outcome when measured at age four years and older

“…[33][34][35][36][37] Information collected from the patients' charts included age at operation, years of follow-up, and age at last follow-up. The type of cataract, laterality, and the presence of pre-and postoperative amblyopia, strabismus, or nystagmus were recorded.…”

Tratamento cirúrgico da catarata pediátrica

“…Segundo trabalhos mais recentes, o índice de opacificação de cápsula posterior em crianças abaixo de 5 anos de idade, aproxima-se de 100% (5)(6)(8)(9)14) , constituindo-se num dos maiores obstáculos à reabilitação visual, agravando-se ainda mais a ambliopia. Várias técnicas para evitar a opacificação secundária do eixo visual têm sido relatadas (4,(6)(7)(8)(9)(15)(16)(17) . Quando não se realiza a capsulotomia/CPP e VA nessa faixa etária, há relatos de até 62,5% dos pacientes terem necessitado de vitrectomia secundária via pars plana, devido à obstrução densa do eixo visual, resistente à abertura com YAG-laser (6) .…”

“…No grupo III a técnica cirúrgica foi considerada mais fácil, pois havia mais suporte para a LIO, visto que a VA e capsulotomia posterior primária foram realizadas após a implantação da LIO dentro do saco capsular. Vale citar como alternativa o método de "vitrectorrexis", para realizar a capsulotomia anterior e posterior, utilizando-se a ponteira de vitrectomia anterior, de preferência com bomba Venturi (16) . A partir do segundo semestre de 2000, iniciamos a realização da capsulorrexe posterior com radiofreqüência, pós-implantação da LIO, introduzindo-se a ponteira da caneta de radiofreqüência sob a parte óptica da LIO.…”

Comparison of anterior vitrectorhexis and continuous curvilinear capsulorhexis in pediatric cataract and intraocular lens implantation surgery: A 10-year analysis

“…[1][2][3][4] High elasticity of the pediatric anterior lens capsule and high posterior vitreous pressure create a tendency for the anterior lens capsule edge to extend peripherally. [1][2][3][4] The younger the child at the time of cataract surgery, the more difficult is the problem, and the more frequent is a "run-away capsulorhexis."…”

“…[1][2][3][4] High elasticity of the pediatric anterior lens capsule and high posterior vitreous pressure create a tendency for the anterior lens capsule edge to extend peripherally. [1][2][3][4] The younger the child at the time of cataract surgery, the more difficult is the problem, and the more frequent is a "run-away capsulorhexis." The purpose of this study was to compare the rate of inadvertent anterior lens capsule tear when performing vitrectorhexis or continuous curvilinear capsulorhexis (CCC) in pediatric cataract and intraocular lens (IOL) implantation surgery by a single surgeon during the decade 1997 to 2006.…”