This patient is having cataract surgery but during capsulorhexis creation, the flap edge seems to get lost. And due to the poor view from multiple cortical spokes, the visualization is poor. How do we proceed at this point? Can we will still achieve an intact capsulorhexis without radialization? Or must we resort to a “can-opener” approach?
One solution is to re-start the rhexis by cutting or nicking the existing capsular opening edge and then continuing with the capsulorhexis. Care must be taken to avoid the issue of having an area of weakness or radialization which could zip around to the posterior capsule and cause significant complications.
The “can-opener” approach will work and by creating many points of anterior capsular weakness, it spreads any forces around thereby decreasing the risk of a posterior extension of one of these capsular tears.
Our solution is to create a new capsulorhexis which is larger than the initial capsular opening so that any irregularity is fully encompassed and any irregular edges are eliminated.
Click below to see the video of this technique in action:
All content is © 2018 by Uday Devgan MD. All rights reserved.