Why are we making a small capsulorhexis?

In many previous videos, we have explained why it is important to have a sufficiently large capsulorhexis. For an optic size of 6 mm in diameter, we want a capsulorhexis that is 5 to 5.5 mm in diameter so that it overlaps for a full 360 degrees. Making a smaller capsulorhexis will only make nucleus removal more challenging and will lead to a smaller effective optic size when the anterior capsular rim opacifies with time.

There are some cases where we want a smaller capsulorhexis and those are cases where there is another surgery performed concomitantly and we want to prevent the optic from escaping from the capsular bag. If we perform DMEK, a glaucoma tube shunt procedure, or a pars plana vitrectomy, then having a 4.5 mm diameter capsulorhexis would make sense.

But in this case, we have none of that. We are simply performing a routine cataract surgery. There is one unusual feature of this eye: it is very myopic, with a long axial length and a large anterior segment. The corneal diameter is about 13 mm. And what appears to be a small capsulorhexis, is actually just about perfect.