Ex Vivo Microsuturing of the Human Anterior Lens Capsule Using 10-0 Sutures: A Technical Feasibility Report.

The human lens capsule is a robust, transparent basement membrane commonly discarded during cataract surgery. Although its use as a biological graft has gained interest in ocular surgery, practical methods for securing the capsule, such as suturing, have not been evaluated. This technical report presents the first in vitro assessment of anterior lens capsule sutureability using fine 10-0 sutures. Anterior capsule specimens were obtained from two patients with pseudoexfoliation syndrome undergoing routine cataract surgery. After being stored for four hours in balanced salt solution (BSS), the specimens, one stained with trypan blue and the other unstained, were spread on a plastic surface (a cellophane sheet: as a non-biologic backing substrate) and sutured using 10-0 nylon (Ethilon™, Ethicon, Raritan, NJ, USA) and 10-0 polyglactin 910 (Vicryl™, Ethicon, Raritan, NJ, USA) under an operating microscope. Both suture types could be successfully passed through the capsule without immediate tearing. The stained capsule enhanced visibility but appeared slightly more fragile, while the unstained capsule demonstrated greater elasticity. Attempts to reapproximate full-thickness capsule tears using sutures were unsuccessful. Viscoelastic agents, including MiniVisc® Plus (Bausch + Lomb, Vaughan, Canada) and DisCoVisc® (Alcon Laboratories, Fort Worth, TX, USA), did not aid in capsule stabilization and reduced visibility during manipulation. No specialized instruments beyond standard ophthalmic tools were used. These findings demonstrate that human anterior lens capsules can tolerate fine suturing in vitro and suggest their potential as suturable biological grafts in applications such as corneal patching, pterygium surgery, or ocular surface reconstruction. However, limitations in tear repair and in vivo behavior require further investigation to establish clinical utility.