Just how big can we make the capsulorhexis? It is a balance: the larger the capsulorhexis, the easier it is to remove the cataract, but we also want to overlap the edges of the IOL optic in order to provide a predictable refractive result and long-term stability.
This patient had cataract surgery of the other eye a year ago with a 5 mm capsulorhexis and a single-piece acrylic IOL with a 6 mm optic. She developed mild anterior capsular phimosis in the post-op period and the capsulorhexis shrunk down to about 4 mm in diameter. We performed anterior capsule relaxing incisions using the YAG laser and this stabilized things.
For her second eye, we are aiming for a 6 mm capsulorhexis, which is the same size as the IOL optic. When she develops mild anterior capsular phimosis in the post-op period, that should bring the capsulorhexis down to about the 5 mm range. We could also do other maneuvers such as placing a capsular tension ring, but we elected not to in this case.
We also find a benefit to a larger capsulorhexis in patients with prior uveitis since the iris will not develop adhesions to the hydrophobic acrylic optic, but they would with the anterior capsular rim. This is a good way to help prevent synechiae.
Click below to see the larger capsulorhexis and a highly efficient surgery: