Age-related Fragility of the Anterior Lens Capsule: A Histopathologic Study of 244 Cataract Surgery Cases

PURPOSE: To identify the clinical and biometric factors associated with the histopathological splitting of the anterior lens capsule in eyes undergoing cataract surgery. SETTING: XXXX University Hospital, XXXXcity, XXXXstate, XXXXcountry(anonymized_for_review). DESIGN: Single-center retrospective cross-sectional study. METHODS: The study included patients who underwent cataract surgery between 2022 and 2025, had an anterior capsulorhexis specimen, and complete clinical data (one eye per patient). Specimens were stained with haematoxylin-eosin and Masson's 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: A total of 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% confidence interval [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 multivariable 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.