title: Extensibility and scanning electron microscopy evaluation of 5 pediatric anterior capsulotomy techniques in a porcine model.
abstract: OBJECTIVE
  To compare the extensibility and scanning electron microscopy (SEM) of 5 currently used pediatric anterior capsulotomy techniques: vitrectorhexis, manual continuous curvilinear capsulorhexis (CCC), can-opener, radio frequency diathermy, and plasma blade in a porcine model.
  
  
  METHODS
  Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.
  
  
  METHODS
  Extensibility was determined by stretching each capsulotomy until it ruptured and measuring it by calculating the mean stretch-to-rupture circumference of each capsulotomy (20 eyes per technique) as a percentage of its baseline circumference. Edge characteristics were evaluated using SEM.
  
  
  RESULTS
  The mean extensibility of each technique tested (vitrectorhexis 161%, CCC 185%, can opener 149%, radio frequency 145%, plasma blade 170%) was significantly different (P<.001, 1-way analysis of variance). The SEM examination found that the vitrectorhexis had a scalloped edge with the whole edge rolled over, presenting a smooth surface toward the inside of the capsulotomy; the manual CCC produced the smoothest edge, with no irregularities noted; the can-opener edge was irregular, showing each puncture of the needle had created a small arc, with occasional regions of the edge rolled over in a "hit-and-miss" fashion; the radio-frequency diathermy capsulotomy edge was ragged, rough, and irregular; and the plasma blade capsulotomy edge was rougher than the manual CCC, but there were fewer irregularities than the radio-frequency diathermy edge had.
  
  
  CONCLUSIONS
  The manual CCC technique produced the most extensible porcine capsulotomy, followed by the plasma blade, vitrectorhexis, can-opener, and radio-frequency techniques, in a porcine model. The manual CCC technique also produced the smoothest anterior capsulotomy edge according SEM evaluation.
authors.affiliation: Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina 29425-5536, USA.
authors.forename: Rupal H
authors.initials: RH
authors.lastname: Trivedi
authors.forename: M Edward
authors.initials: ME
authors.lastname: Wilson
authors.forename: Luanna R
authors.initials: LR
authors.lastname: Bartholomew
mesh_terms: D000818:Animals; D019923:Capsulorhexis / Q000379:methods*; D007903:Lens Capsule, Crystalline / Q000601:surgery* / Q000648:ultrastructure*; D008855:Microscopy, Electron, Scanning; D023421:Models, Animal; D013552:Swine