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Age-related fragility of the anterior lens capsule: histopathologic study of 244 cataract surgery cases
Masanobu Iida1, Yoichiro Masuda, Mari Yamazaki
1From the Department of Ophthalmology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan (Iida, Masuda, Yamazaki, Ichihara, Komatsu, Nakano); Honancho Eye and Tear Clinic, Suginami-ku, Tokyo, Japan (Ichihara); Department of Ophthalmology, Machida Municipal Hospital, Machida-shi, Tokyo, Japan (Komatsu); Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan (Iwauchi, Kubota, Shimoda).
Purpose:
To identify the clinical and biometric factors associated with the histopathological splitting of the anterior lens capsule in eyes undergoing cataract surgery.
Setting:
The Jikei University Hospital, Minato-ku, Tokyo, Japan.
Design:
Single-center retrospective cross-sectional study.
Methods:
The study included patients who underwent cataract surgery between 2022 and 2025 and had an anterior capsulorhexis specimen and complete clinical data (1 eye per patient). Specimens were stained with hematoxylin-eosin and Masson trichrome and assessed for capsular splitting. Collected variables were age, sex, nuclear hardness (Emery-Little classification), diabetes mellitus, axial length, and lens thickness. Factors associated with splitting were examined using logistic regression.
Results:
244 patients (244 eyes) were included. Capsular splitting was observed in 69 of 244 eyes (28.3%). In univariable analysis, older age (per 1-year increase: odds ratio [OR], 1.121; 95% CI, 1.081-1.162; P < .001), nuclear hardness grade ≥3 (OR, 2.821; 95% CI, 1.379-5.771; P = .005), shorter axial length (per mm: OR, 0.763; 95% CI, 0.648-0.900; P = .001), and greater lens thickness (per mm: OR, 4.224; 95% CI, 2.232-7.993; P < .001) were significantly associated with splitting. Sex and diabetes mellitus were not associated with splitting. In multivariate analysis, which included variables significant in the univariable analysis, only age remained independently associated with splitting (per 1-year increase: OR, 1.105; 95% CI, 1.062-1.151; P < .001).
Conclusions:
Capsular splitting is primarily age-related. These results suggest progressive weakening of the anterior lens capsule with increasing age.
