Our CataractCoach.com readers understand the challenges of white cataracts and in particular, intumescent white cataracts. With a capsular bag that is filled with liquefied lens cortex, it becomes pressurized and can cause great difficulty in creating a capsulorhexis. In this case, the resident surgeon ran into trouble and the capsulorhexis radialized out to the zonular attachments. What should you do now?
The danger of having just one area of radialized anterior capsule is that any forces on the capsular bag will all be directly transmitted to this area which can cause it to rip all the way to the posterior capsule. Then the wide open posterior capsule greatly increases the risk of vitreous prolapse into the anterior segment and then nucleus displacement into the vitreous cavity. In this case, the resident is able to use the small scissors to start another point for tearing the capsulorhexis and complete the case. Note that care is taken to avoid stress on the capsular bag to prevent further tear out of the capsule.
For a review of the challenges and techniques for white cataracts, please see this comprehensive guide.
Click the video below to learn how to rescue this run-out capsulorhexis: