When to Revert to a Can-Opener Capsulotomy

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We have learned from the past two days of videos, that it is sometimes wise to revert to a can-opener capsulotomy when the capsulorhexis is radialized. This is a case presented by guest surgeon Dr. Eduardo Tomazoni who is an ophthalmology resident at Governador Celso Ramos hospital in Brazil. This case starts begins with a junior resident operating and there is a radialization of the capsulorhexis toward the lens equator, but it gets worse: as the forceps are pulled out of the eye, the subincision capsule is inadvertently grabbed and that, too, radializes. Now with two areas of capsular tear-out, what is the best move?

This is a good situation in which to perform a can-opener capsulotomy. This creates a round opening in the anterior lens capsule and also creates multiple sites where capsular bag stress can be dissipated.  If we instead try to do a capsulorhexis and leave just one or two areas of runout, these areas will absorb all of the capsular forces and that will lead to further runout of the tear, all the way to the posterior capsule.

Watch this video carefully because there is a lot to learn from Dr. Tomazoni. He did a great job in rescuing this surgery. The next time you have a capsular runout, ask for the cystotome and perform a can-opener capsulotomy.

Click below to see this instructional video:

 

2 Comments

  1. Hi dr Devgan. Thank you for your great videos.i learn so much from you and I’m so thankful. My question is in a radialized capsulorhexis, does pulling cortical material cause in extending the tear to the posterior capsule? And what if we left some cortex in the site of tear. And can we insert the IOL and then remove the cortex after that? Does it lessen the risk of extending radializiaton? Thank you so much

    1. Yes those are good options. During cortex removal be careful not to grab the capsular edge near the tear. Remove cortex near weak area last and sometimes it is helpful to insert the IOL first

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