Performing cataract surgery in a 2-month-old infant requires a specialized approach due to the high elasticity of the pediatric capsule and, in this case, the presence of a fibrotic anterior capsule plaque. In these cases, a standard manual capsulorhexis is very difficult, as the capsule tends to tear peripherally or is resistant to tearing. To maintain control, surgeons often utilize a vitrector-cut capsulotomy (vitreorhexis). After staining with trypan blue, the vitrector probe is placed against the anterior capsule. Using variable cutting rates and low vacuum, the vitrector creates a circular, centered opening by nibbling the fibrotic tissue. This technique is particularly advantageous in infants because it allows for a simultaneous posterior capsulotomy and limited anterior vitrectomy, which are essential to prevent the rapid development of secondary visual axis opacification. By using the vitrector, the surgeon ensures a stable, sized opening that resists the contractile forces of the healing pediatric eye.
