Anterior Capsulotomy: Intraoperative Performance and Tear Rate During Pediatric Cataract Surgery

Abstract

Purpose: Management of the anterior lens capsule in pediatric cataract surgery (PCS) has historically been a challenge. The purpose of this study was to evaluate the intraoperative outcomes of various anterior capsulotomy techniques as regards radial tears. Methods: Consecutive PCSs performed by a single surgeon were retrospectively reviewed. Five capsulotomy techniques were utilized (vitrectorhexis, manual continuous curvilinear capsulorhexis (CCC), radiofrequency diathermy (RF), plasma blade (PB), and can opener). Outcomes data were compiled and divided into pseudophakic nontraumatic cataract, pseudophakic traumatic cataract, and aphakic eyes. Results: Five hundred eleven eyes were analyzed. Of 339 pseudophakic eyes, intraoperative radial tears developed in 40 (11.8%). A tear developed in 20/221 eyes (9.0%) when using vitrectorhexis, 10/94 (10.7%) CCC, 4/15 (26.7%) RF, 5/7 (71.4%) PB, and 1/2 can-opener technique. These tears occurred during anterior capsulotomy in 15 eyes, cataract removal in 11, IOL insertion/manipulation in 13, and posterior capsulotomy in 1 eye. In eyes operated for cataract before 6 years of age, the manual CCC technique was more likely to develop a radial tear (relative risk: 2.9), compared to eyes of older children (=6 years of age) where the vitrectorhexis technique was more likely to develop a radial tear (RR: 1.9). Of the 103 eyes that were left aphakic, none developed a radial tear during PCS. An additional 68 eyes had traumatic cataracts. Twenty-five of these had preexisting tears from preoperative trauma, and three developed intraoperative tears. Conclusions: Vitrectorhexis was ideally suited for use in children.