Comparative evaluation of anterior lens capsule electron microscopic pathology in a case undergoing simultaneous bilateral cataract surgery: A study of CAPSULaser and continuous curvilinear capsulorhexis

Abstract

Purpose

To identify ultrastructural changes, such as thermal effects and lens cortex penetration, to assess the potential benefits of CAPSULaser for future use in patients with complex cataract conditions.

Observation

Histological examination of the CAPSULaser-treated tissue revealed sections of the anterior capsule, cuboidal epithelial cells, and lens cortex collagen fibers. The edges of the tissue were slightly bent toward the anterior side, displaying a thermal effect measuring 62.12 μm in width. The tissue strip showed irregular thickness, with a maximum lens cortex collagen fiber thickness of 237.1 μm. Under TEM, the capsular margins appeared fragmented, exhibiting bulbous edges and a bubbly appearance. In the cauterized areas, electron-dense materials obscured and distorted the attached epithelial cells and lens fibers, in contrast to the preserved central region. Conversely, light microscopy of the CCC specimen showed sharp, well-demarcated edges tapering from anterior to posterior, and it was thinner than the CAPSULaser specimen. Notably, the CCC specimen lacked lens cortex collagen fibers, consisting solely of the anterior capsule and cuboidal epithelial cells. Ultrastructurally, the CCC specimen's edges appeared angulated and well-dermacated.

Conclusion and importance

Our study indicates that the cauterized edges of the CAPSULaser specimen tend to fold toward the anterior side, emphasizing the role of collagen phase changes in enhancing tissue elasticity. This study reported both histopathological and TEM findings, particularly for CAPSULaser, offering valuable insights into the microscopic changes in the anterior capsule when comparing CCC and CAPSULaser.