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

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.