Run Away Capsulorhexis: What is your next move?

This patient has an intumescent white cataract and our surgeon, an ophthalmology resident with about 200 cataract surgeries completed, wishes to try a capsulorhexis using a small incision and a pressurized anterior chamber.

The resident surgeon is right-handed, so a paracentesis is made for the right hand, the anterior capsule is stained with trypan blue dye and there is a generous fill of the anterior chamber with viscoelastic. Since we know that the capsular bag is filled and pressurized with liquefied lens cortex, we will fill the anterior chamber so that it has an even higher pressure. We have just the one small incision because if we make the 2 to 3 mm phaco incision now, we will not be able to create a sufficiently high pressure as the viscoelastic would just tend to egress from the incision.

The capsulorhexis starts out well, but then starts to radialize. It would prove quite difficult to control it and bring it back in for a normal 5 mm capsulorhexis, so the advice I gave was to just quickly turn it into a small “baby” rhexis. This small opening of about 2 mm in diameter is not intended for performing phacoemulsification, but rather just to stabilize it so that the capsular bag could be thoroughly depressurized. At this point, the main incision can be made and we can safely turn this into a larger 5 mm capsulorhexis.

Click below to learn from this important rescue technique: