Capsulotomy

Capsulotomy is a surgical procedure that creates an opening in a capsule, a fibrous envelope surrounding a body structure. The term is used across medical specialties, most often in ophthalmology.

In ophthalmology, capsulotomy refers to procedures involving the crystalline lens capsule. An anterior capsulotomy, typically performed during cataract surgery, creates a continuous circular opening in the anterior capsule (capsulorhexis) to enable removal of the cloudy lens and placement of an intraocular lens. The technique and size of the opening are optimized to maintain capsule integrity and support intraocular lens positioning. A posterior capsulotomy is used to treat posterior capsule opacification (PCO), a common postoperative complication after cataract extraction. This opening is usually created with a Nd:YAG laser, delivering a controlled disruption of the opacified posterior capsule without intraocular surgery. In rare cases where laser treatment is unsuitable, a surgical posterior capsulotomy may be performed.

Apart from the eye, capsulotomy can describe a neurosurgical procedure that creates a lesion or disruption of the internal capsule or other neural capsules to treat severe obsessive-compulsive disorder or other neuropsychiatric conditions. These procedures are specialized, risk-laden, and less commonly used today, with deep brain stimulation often preferred. Risks in ophthalmic capsulotomy include tearing of the capsule, intraoperative rupture, vitreous loss, increased intraocular pressure, cystoid macular edema, and damage to intraocular structures. Proper case selection and technique mitigate these risks.