Rescuing the Radialized Capsulorhexis

radialized rhexis

The capsulorhexis is an important early step of cataract surgery because it gives strength to the capsular opening so that we can perform lens fragmentation and removal within the capsular bag. But what should we do when the capsulorhexis radializes out to the zonules? How can we complete the capsulorhexis and safely continue with the surgery?

In this cataract surgery, the capsulorhexis radializes to the zonules and I perform maneuvers to complete the capsulorhexis the other direction. Here I use a sharp side-port blade (MVR style) to nick the capsule and complete the capsulorhexis in the other direction. The capsulorhexis is complete but there is a weak area that must be avoided. To prevent stress on this area, we use the 27ga cannula to dial the cataract nucleus out of the capsular bag and into the iris plane, held in place by the pupil.

Finally we finish the case successfully by placing the IOL in the capsular bag. All of this was accomplished in the setting of floppy iris syndrome and the pupil becoming smaller.

Click below to see how we successfully handled this radialized capsulorhexis:

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  1. Beautiful. I would be worried that when you bring the nucleus out of the bag that it puts extra stress on the anterior capsule which could radialize it further posteriorly? How is that not the case? Thank you for all you do!

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