In this brief video, we are doing surgery to address a white cataract and we encounter an issue with an errant tear in the anterior lens capsule during our capsulorhexis procedure. The risk here is Argentinian Flag Sign where pressure from the lens nucleus causes the tear to run-out all the way to the zonular structures and this creates a high risk situation.
During the pre-operative consultation, the cataract did not appear to be intumescent from liquified cortex material. We have illustrated the keys to differentiating white cataracts in a prior article here on CataractCoach, so please review that if needed.
When we started the capsulorhexis it appeared to behave normally, then a combination of patient movement and other factors lead to an errant tear in the capsule. For safety, the capsulorhexis was completed quickly in a small form, then the capsular bag was depressurized and the lens nucleus was manipulated to ensure that no posterior pressure was present.
At this point, we used the side-port blade to nick the edge of the small capsulorhexis and then grabbed this with forceps to create a larger and more appropriately sized capsulorhexis. This is the double rhexis technique that is useful for intumescent white cataracts.
Click below to see this double capsulorhexis technique in action: