Performing the capsulorhexis is one of the most stressful steps for new ophthalmologists who are beginning to learn cataract surgery. This step can be unforgiving and in certain cases, it is more challenging. In this video, the patient has thin and friable anterior capsule which has become less elastic after staining with trypan blue. In addition, this patient is having a hard time holding still and her general health problems are preventing her from having a deeper level of systemic sedation.
As we begin the capsulorhexis, we use the chopper in the side-port to fixate the eye in an attempt to hold it still despite the patient’s poor level of cooperation. The central capsule is grabbed and an attempt at a circular tear is made. This becomes irregular as a sudden eye movement is enough to over-power the fixation by the chopper and this causes another tear out.
The key to completing this case is to spiral out the capsulorhexis and then to make sure that the area of irregular tear is encompassed by the completed and intact capsulorhexis. This ensures that there are no weak edges or areas that could radialize and cause complications during the phaco process.
Click below to learn how to rescue this capsulorhexis: