An experimental study comparing various anterior capsulectomy techniques
E. I. Assia, D. J. Apple, A. Barden, J. C. Tsai, V. E. Castaneda and J. S. Hoggatt
Department of Ophthalmology, Medical University of South Carolina, Charleston 29425.
Radial tears at the margin of an anterior capsulectomy may be associated
with the exit of at least one loop of an intraocular lens out of the
capsular bag ("pea pod" effect) and subsequent decentration. Many
ophthalmologists have gained a clinical impression that the anterior
capsule is more likely to remain intact if the continuous circular
capsulorhexis (CCC) technique is used. However, controlled comparison of
the incidence of radial tears with the use of different capsulectomies
under standardized conditions has not been performed, to date. In this
study, we analyzed the incidence of radial tear formation in 40 human eyes
that were obtained post mortem. These eyes were randomized to four
technique groups: (1) "can opener," (2) linear capsulotomy, (3)
capsulopuncture, and (4) CCC. We demonstrated that the CCC technique is
much less likely to cause or be associated with anterior capsular radial
tears as opposed to the other three techniques. With the technique of
nuclear expression used in this study, radial tears occurred in 100% of
cases treated with the can opener, linear capsulotomy, and capsulopuncture
techniques, whereas no tears occurred with the CCC technique. This study
provides convincing evidence that the CCC is the best available anterior
capsulectomy procedure to minimize the incidence of radial tears.
