A preliminary comparative study of peripheral capsular linear incision versus circular micro-tear capsulotomy for in situ lens regeneration

In congenital cataract, conventional circular micro-tear capsulotomy often causes loss of anterior capsular lens epithelial cells, thereby impairing the integrity and transparency of the regenerated lens. Based on the concept of minimal capsulorhexis, we performed a preliminary pilot investigation using a 1.5 mm linear incision in the peripheral capsule to evaluate whether this technique could improve lens regeneration outcomes. Forty 4-week-old New Zealand white rabbits were randomly allocated to two groups: peripheral capsular linear incision (Group A) and circular micro-tear capsulotomy (Group B), with 20 rabbits per group. All surgeries were performed by the same experienced surgeon. Detailed surgical procedures are described below. Postoperatively, regenerated lenses were assessed for morphology, size, weight, transparency, and capsular healing, followed by histological analysis. Successful lens regeneration was observed in both groups. Group A showed superior regenerative outcomes, with more intact lens morphology, higher transparency, and greater lens weight and thickness compared with Group B. Histological examination revealed that epithelial cells in Group A differentiated into well-organized lens fibers with more orderly arrangement, faster capsular healing, smaller scars, and smoother capsular surfaces than those in Group B. Our preliminary pilot study indicates that peripheral capsular linear incision may offer potential advantages over small circular micro-tear capsulotomy in promoting morphological and functional lens regeneration and capsular healing in rabbit eyes. These findings may provide novel surgical strategies for lens regeneration in children with congenital cataracts.