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Capsulotomy

Capsulotomy is a type of eye surgery that involves making an incision in the capsule of the crystalline lens. There are two main types - anterior capsulotomy performed during cataract surgery, and posterior capsulotomy months or years later if the lens capsule becomes opaque. Anterior capsulotomy techniques include can opener capsulotomy, envelope capsulotomy, manual capsulorhexis, and femtosecond laser-assisted capsulotomy. Posterior capsulotomy is typically performed using a YAG laser in a cruciate or circular pattern to clear opacity while avoiding making the opening too large.

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Adrian Pearl
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871 views

Capsulotomy

Capsulotomy is a type of eye surgery that involves making an incision in the capsule of the crystalline lens. There are two main types - anterior capsulotomy performed during cataract surgery, and posterior capsulotomy months or years later if the lens capsule becomes opaque. Anterior capsulotomy techniques include can opener capsulotomy, envelope capsulotomy, manual capsulorhexis, and femtosecond laser-assisted capsulotomy. Posterior capsulotomy is typically performed using a YAG laser in a cruciate or circular pattern to clear opacity while avoiding making the opening too large.

Uploaded by

Adrian Pearl
Copyright
© © All Rights Reserved
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Download as PPTX, PDF, TXT or read online on Scribd
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Capsulotomy
 Capsulotomy
• Capsulotomy is a type of eye surgery in which an incision is made into
the capsule of the crystalline lens of the eye.

Based on the location:


• Anterior Capsulotomy
• Posterior Capsulotomy
Anterior Capsulotomy
• Part of cataract surgery

Types of Anterior Capsulotomy in Cataract Surgery:


Sharma B, Abell RG, Arora
• Can opener capsulotomy T, Antony T, Vajpayee RB.
• Envelope capsulotomy Techniques of anterior
capsulotomy in cataract
• Manual capsulorhexis surgery. Indian J
• Femto second laser-assisted capsulotomy Ophthalmol. 2019
• Plasma blade capsulotomy Apr;67(4):450-460. doi:
10.4103/ijo.IJO_1728_18
• Precision Pulse Capsulotomy (PPC)/Zepto https://www.ncbi.nlm.nih.go
v/pmc/articles/PMC6446625
/
Can opener capsulotomy

• The technique involves creation


of a circular opening 5–6 mm in
diameter by series of small tears
in the anterior capsule with a
cystitome
• Cystitome can be made by either
bending a 26-gauge needle or
using a prefabricated
commercially available cystitome.
• commonly employed for doing
extracapsular cataract surgery
• While can opener capsulotomy is easy to perform, the characteristic weakness associated
with its ragged edges makes it unsuitable for phacoemulsification.
• The main complication associated with can opener capsulotomy is occurrence of anterior
capsular radial tears  the capsular bag unstable and besides interfering in aspiration of
cortical matter can also affect the centration of IOL.
• Moreover, if significant pressure is created in capsular bag, these radial tears can extend
through zonules causing occurrence of catastrophic posterior capsular (PC) tears.
• Also, tags can occlude aspiration port and impede removal of cortical lens matter. If too much
aspiration force is used during cortical clean-up, anterior capsular tags can be pulled, and
cause PC ruptures, vitreous disturbance and pea podding of IOL
Envelope capsulotomy Unlike can opener capsulotomy, it can ensure a
successful in the bag implantation of a posterior
Envelope capsulotomy involves making a
chamber IOL
linear incision in upper 1/3 of anterior After complete removal of cataract, radial cuts are
capsule, followed by nucleus delivery and made at ends of incision with Vannas scissors and
intercapsular aspiration of cortical matter capsular flap is torn off like in capsulorhexis.

Envelope technique is considered to be very useful in white cataracts where it provides a scaffold for nucleus removal and lens implantation
Major advantages:
• minimal trauma to corneal endothelium
• good centration of IOL.

Complications:
• IOL tilt and decentration An inadvertent occurrence of asymmetrical capsular
flaps may cause upward decentration of IOL.
• Postoperative dyscoria sometimes, incompletely removed capsular flaps can
generate free floating capsular tags that get stuck to the pupillary margin causing
postoperative dyscoria
• Incidences of zonular disruption
Manual Capsulorhexis
• Manually, the capsulorhexis can be
fashioned by creating a small tear in
the center of the anterior capsule and
later advancing the resulting capsular
flap into a circular shape by guiding
the leading edge with the cystitome

• Alternatively, the capsular flap can be


pulled in a circular fashion by
grasping the leading edge with a Continuous curvilinear capsulorhexis can be fashioned
forceps and advancing the tear with by creating a small tear in the center of the anterior
frequent regrasping. 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
Complications :
• anterior capsular radial tears can occur with CCC, if the CCC margin is
stretched too much radial tear may still extend to the peripheral
part of lens mostly due to an increase in intracapsular pressure
Manual Capsulorhexis Femto second laser-assisted capsulotomy

Precision Pulse Capsulotomy (PPC)/Zepto


Posterior Capsulotomy
• Months or years after the cataract operation, the
lens capsule can become opaque in about 30% of
eyes.
•  YAG laser capsulotomy
• The two primary techniques are:
Cruciate Pattern & Circular Pattern
• The laser settings depend on the density of the
fibrous growth and vary from about 2 to 6 mJ per
spot
• The total number of spots also varies and it
typically between 10 and 30
• The ideal YAG capsulotomy
size is just enough to account
for the pupil size, including in
dark lighting situations.
• The posterior capsulotomy in
any dimension, should never be
bigger than the optic size of the
IOL which is typically 6mm 
prevent vitreous from
prolapsing around the optic and
into the posterior chamber and
even anterior chamber. 
Before ------ After
Side effects :
• transient rise in the intraocular pressure (IOP)
• persistent floaters

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