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Age, lens capsule elasticity determine safest technique for pediatric cataract surgery

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Vitrectorhexis is safer and more effective than continuous curvilinear capsulorrhexis in cataract surgery performed in children under 6 years of age due to their highly elastic anterior lens capsule, according to a study by researchers in South Carolina.

However, manual continuous curvilinear capsulorrhexis is best for children aged 6 years and older because capsule control and ease of capsulotomy completion have improved by that age, the study authors said.

M. Edward Wilson Jr., MD, and colleagues investigated the rate of inadvertent anterior lens capsular tears with vitrectorhexis and continuous curvilinear capsulorrhexis in 737 pediatric eyes that underwent cataract and IOL implantation surgery between January 1997 and December 2006.

Patients with a lens capsule that ruptured preoperatively were excluded from the study. Additionally, the cases of 27 eyes that received an anterior capsulotomy by another method and 100 eyes that did not receive an IOL were reviewed, but excluded from the final comparative analysis, the authors noted.

Of the remaining 339 eyes, 19 eyes (5.6%) developed an anterior capsule tear. Specifically, 12 of 226 eyes (5.3%) that underwent vitrectorhexis and seven of 113 eyes (6.2%) that underwent continuous curvilinear capsulorrhexis developed capsule tears, the authors reported.

These tears occurred during anterior capsulotomy in seven eyes, hydrodissection in one eye, cataract removal in three eyes and IOL insertion or manipulation in eight eyes, they found.

In the eyes of patients that underwent cataract surgery at 72 months of age or younger, the continuous curvilinear capsulorrhexis technique was more likely to develop a tear, resulting in a relative risk of 3.09.

In the eyes of children over 72 months of age, the vitrectorhexis technique was more likely to develop a tear, and the relative risk was 3.14, according to the study.

The study is published in the October issue of Journal of American Association for Pediatric Ophthalmology and Strabismus.