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Capsulorhexis

Capsulorrhexis is a technique used to remove the lens capsule during cataract surgery. The spelling has varied between having one or two "r"s. It generally refers to removal of a part of the anterior lens capsule, but in situations like a developmental cataract a part of the posterior capsule is also removed by a similar technique. It is also termed Continuous Curvilinear Capsulorhexis , the term describing the exact surgical technique. Shear and stretch forces are used. Howard Gimbel was the pioneer in the technique.In order to remove a cataract with modern techniques, the capsule of the lens must be opened. In older style surgery , the whole lens and capsule was removed. This was done to prevent the inflammatory response to leftover lens material. Since it was all removed en-bloc, there was no residual. With modern techniques, however, the removal of practically all the material can be achieved while leaving the intact capsule. This is important since it provides a barrier between the front and back of the eye, and prevents the vitreous from moving forwards. In addition, this allows the artificial intra-ocular lens an ideal place to be located in the eye, away from contact with other structures yet solidly held in place. Prior to the advent of the CCC, a "can opener" approach was used, with a small bent needle making small incisions around the anterior surface of the lens, forming a somewhat continuous hole that the lens could be removed through. However, any of these ragged edges could promote a tear that could proceed outwards. A CCC when done correctly, does not have any edges, and any forces applied to the capsule during surgery are distributed and do not result in a tear.The usual method is to use the same bent needle to begin a tear in the capsule, and then either guide the edge with the same needle around the anterior surface, or use a special forceps to do the same. There are advantages and disadvantages of both approaches, and most surgeons will use both instruments as the situation requires.As noted, in children, often an anterior and posterior capsulrrhexis is made, since the posterior capsule becomes cloudy even more commonly in children than adults. Since a simple office procedure using a YAG:Nd laser commonly performed on adults is difficult with a child , it is better to deal with the posterior capsule at the time of surgery. Since the vitreous in children is much more formed, the loss of vitreous is less common , though often an anterior vitrectomy is still performed. Carbon Monoxide Poisoning (From the Wikpedia article Capsulorhexis.)

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Recent Publications on Capsulorhexis:

Pubmed Logo
New technology for sizing the continuous curvilinear capsulorhexis: Prospective trial.
PURPOSE: To evaluate the deviation of the continuous curvilinear...
24th June, 2008
From the Center for Vision Science (Dick, Manns, Pena-Aceves), Ruhr J Cataract Refract Surg. 2008 Jul;34(7):1136-44.
DOI Direct Link
A new technique for the closure of the lens capsule by laser welding.
A new method is presented for the closure of the lens capsule based on...
18th June, 2008
Istituto di Fisica Applicata, Consiglio Nazionale delle Ricerche, Firenze, Ophthalmic Surg Lasers Imaging. 2008 May-Jun;39(3):260-1.
Intraocular lens calculation accuracy limits in normal eyes.
PURPOSE: To quantify the current accuracy limits, analyze the residual...
17th June, 2008
University Eye J Cataract Refract Surg. 2008 May;34(5):802-8.
DOI Direct Link
Intraindividual comparison of color contrast sensitivity in patients with clear and blue-light-filtering intraocular lenses.
PURPOSE: To evaluate the effect of blue-light-filtering intraocular lenses...
17th June, 2008
Department of Ophthalmology, Medical University of Vienna, Vienna, J Cataract Refract Surg. 2008 May;34(5):769-73.
DOI Direct Link
Anterior chamber depth and change in axial intraocular lens position after cataract surgery with primary posterior capsulorhexis and posterior optic buttonholing.
PURPOSE: To compare axial position changes of the intraocular lens (IOL)...
17th June, 2008
Department of Ophthalmology and Optometry, Medical University of Vienna, J Cataract Refract Surg. 2008 May;34(5):749-54.
DOI Direct Link

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Capsulorhexis Clinical Trials:

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DY001: Safety and Effectiveness of DYME as an Agent for Selective Staining of the Anterior Capsule During Cataract Surgery
Mature Cataracts
DY002: Safety and Effectiveness of DYME as an Agent for Selective Staining of the Anterior Capsule During Cataract Surgery
Mature Cataracts

Capsulorhexis Patents:

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US Patent No.Title
6290670 Device for removing pathological centers for use in humans and animals
6425917 Phakic iol film frame
6454802 Intraocular lens implant for the prevention of secondary cataracts
6494911 Accommodating intraocular lens
6533769 Method for use in cataract surgery

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Wikipedia excerpt, where present, licenced under the GNU Free Documentation License. Resources from the NCBI applied. Selected MeSH subject headings created and maintained by the US NLM are used in conjunction with additional keywords. 2006-2008 MeSH.
 

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