Use of capsulorhexis and Healon 5 in children younger than 5 years of age

This short report details the success of manual continuous curvilinear capsulorhexis (CCC) in young children when the technique is supported by the use of Healon 5 (Advanced Medical Optics, Santa Ana, CA). Although manual CCC routinely is performed in adults and older children undergoing cataract surgery, it is harder to perform in young children. Tearing the capsule is harder to control on account of the increased elasticity of the juvenile lens capsule and also because of increased positive pressure from the vitreous as a result of reduced scleral rigidity. This problem has led to the development of alternative manual(1-4) and mechanised capsulotomy methods.(5,6) Although the mechanized methods are easier to perform, manual CCC has remained the gold standard against which to compare the effectiveness of any new capsulotomy technique.(7,8) High molecular weight viscoelastics are thought to assist the control of the manual CCC by resisting positive vitreous pressure and flattening the anterior capsule. Healon 5 is associated with a higher chance of completing manual continuous curvilinear capsulorhexis in children compared with lower viscosity viscoelastics.(9) Our case series supports this finding but in a much younger age group of patients.