Management of the Anterior Capsule
To enable access to the lens nucleus and cortex during cataract surgery, a capsulorrhexis is performed. Because the tearing characteristics of the pediatric capsule are quite different from those of the adult capsule, lens removal techniques are modified for pediatric patients so that the risk of inadvertent extension of the tear is minimized. The elasticity of the capsule is greatest in younger patients, especially infants, making continuous curvilinear capsulorrhexis more difficult. The pulling force should be directed nearly perpendicular to the direction of intended tear, and the capsule should be regrasped frequently to maintain optimal control over the direction of tear. An alternative to capsulorrhexis in infants is vitrectorhexis, the creation of an anterior capsule opening using a vitrectomy instrument. In children with dense cataracts that obscure the red reflex, visibility of the anterior capsule can be enhanced with application of trypan blue ophthalmic solution 0.06% to the capsule.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.