Capsular Outcomes Differ with Capsulorhexis Sizes after Pediatric Cataract Surgery: A Randomized Controlled Trial

Abstract

Capsular outcomes of anterior/posterior capsulorhexis opening (ACO/PCO) are essential for performing a secondary in-the-bag intraocular lens implantation. To compare the capsular outcomes with different primary capsulorhexis sizes, Thirty-eight eligible patients (45 eyes) were randomly assigned to three groups by anterior capsulorhexis diameter (Group A: 3.0–3.9, Group B: 4.0–5.0, and Group C: 5.1–6.0 mm). The areas of ACO/PCO and posterior capsule opening opacity (PCOO) as primary outcomes, while, the incidence of visual axis opacity (VAO) as secondary outcome were measured at follow-up visits. Among the thirty eyes included in the final analysis, the mean area of the ACO decreased significantly, whereas the PCO enlarged with time. Group A had the highest anterior capsule constriction and percentage reduction, which increased with time. There were significant differences in the percentage reductions at 6 months and 1 year compared to 1 month in Group A and B. Group C had the highest posterior capsule enlargement. The percentage of PCOO to PCO area and the incidence of VAO was highest in Group A and lowest in Group C. Thus, Capsulorhexis diameter of 4.0–5.0 mm may yield better capsular outcomes, considering moderate contraction of ACO, moderate enlargement of PCO, and lower percentage of PCOO and VAO.

Updates on managements of pediatric cataract

“…Some studies described its use in pediatric cataract surgery for both the anterior and posterior capsule and reported no complications 32, 33. The problem with this method is that when we are doing capsulotomy by radio-frequency, it leaves some small tags behind, and the rhexis edge is not as sharp as a manual tear 34, 35, 36…”

Anterior Capsule Opening Contraction and Late Intraocular Lens Dislocation after Cataract Surgery in Patients with Weak or Partially Absent Zonular Support

“…Other studies have reported PEX syndrome as a major risk factor for late IOL-capsular bag dislocation [ 2 , 3 , 9 , 54 ]. Capsular and anterior capsule openings were not analyzed in these studies, but capsular contraction and phimosis occlusion of the capsulorhexis opening after cataract surgery is a well-known characteristic of PEX syndrome [ 18 , 34 , 55 ].…”

Changes to the Anterior Capsular Opening of Human Lens after Cataract Surgery in Patients with Subluxated Lenses. Summary of the Doctoral Thesis

“…In the group with an average sized capsulorrhexis, the results of the same visits were an initial size of 15.22 mm 2 , then 13.43 mm 2 in the 1 st month and 12.79 mm 2 in the 6 th month, with the percentage reduction being 12.92 % and 15.95 %, respectively. In the group with the largest initial capsulorrhexis (22.92 mm 2 ), the reduction after 1 month was up to 20.86 mm 2 (8.88 %), and 20.49 mm 2 (10.55 %) 6 months post-surgery (Lin et al, 2015). The capsulorrhexis of the study patients was not enlarged, as the author's view is that this is an additional manipulation which can deepen an already weakened zonular defect or damage preserved zonules, aggravating the post-surgery outcome prognosis in this way.…”