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Review
. 2019 Apr;67(4):450-460.
doi: 10.4103/ijo.IJO_1728_18.

Techniques of anterior capsulotomy in cataract surgery

Bhavana Sharma  1 , Robin G Abell  2 , Tarun Arora  3 , Tom Antony  1 , Rasik B Vajpayee  4
Affiliations
Review

Techniques of anterior capsulotomy in cataract surgery

Bhavana Sharma et al. Indian J Ophthalmol. 2019 Apr.

Abstract

Optimal outcomes of a cataract surgery largely depend on the successful performance of an anterior capsulotomy. It is one of the most important steps of modern cataract surgery which reduces the risk of capsular tears and ensures postoperative stable intraocular lens (IOL). Anterior capsulotomy is considered ideal if it is round, continuous, well-centered, and overlaps the implanted IOL around its circumference. If any of these features is missing, it can be a cause of impedance for desired surgical and visual outcomes. Manual can opener and manual capsulorhexis are the routine standard techniques employed for manual extracapsular cataract extraction and phacoemulsification, respectively. Recent increasing use of femtosecond laser cataract surgery has allowed cataract surgeons to obviate inherent inaccuracies of manual anterior capsulotomy techniques. There is an ongoing quest to find an ideal, risk free, and surgeon-friendly technique of anterior capsulotomy that can be employed for surgery in all types of cataracts.

Keywords: Capsulorhexis; Femto laser; Zepto laser; capsulotomy; pediatric capsulotomy; plasma blade.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Can opener capsulotomy is performed by making a series of small tears in the anterior capsule using a cystitome
Figure 2
Figure 2
(a–c) Envelope capsulotomy involves making a linear incision in the upper one-third of the anterior capsule. After removal of the nucleus and cortical matter, radial cuts are made and the capsular flap is torn similar to capsulorhexis
Figure 3
Figure 3
Continuous curvilinear capsulorhexis can be fashioned by creating a small tear in the center of the anterior capsule and ladvancing the resulting capsular flap into a circular shape by guiding the leading edge with the cystitome or by by grasping the leading edge with a forceps and advancing the tear with frequent regrasping
Figure 4
Figure 4
Scanning electron microscopy of manual capsulorhexis demonstrating the smoothness of the edges
Figure 5
Figure 5
Femtosecond laser capsulotomy has an inherent architecture of near-continuous series of postage-stamp like microperforations
Figure 6
Figure 6
Scanning electron microscopy of femtosecond capsulotomy shows aberrant laser shots and a rough edge
Figure 7
Figure 7
Scanning electron microscopy of precision pulse capsulotomy showing relatively smoother edge as compared to femtosecond laser-assisted capsulotomy
See this image and copyright information in PMC

References

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