Resident Double Capsulorhexis for White Cataract

We know that intumescent white cataracts have a pressurized capsular bag with the milky white, liquefied cortex material. And we have shown many different techniques for safely dealing with this, with my favorite being the double capsulorhexis technique.

This video shows a senior resident successfully performing this double capsulorhexis technique, including using micro-scissors to start the second capsulorhexis. There is great learning here for young ophthalmologists and great review for seasoned surgeons.

Click below to watch and master the double capsulorhexis technique:


  1. How would you handle this same cataract with a very small pupil? One requiring a Malyugin ring. Do you inject dye a second time to stain the peripheral capsule after inserting the ring or do you initially inject dye under the iris before making your main incision?
    Thank you

    1. Two options: (1) insert your device then aspirate the viscoelastic our of the eye, stain with blue dye, and refill with viscoelastic. Or (2) do this technique of putting a small aliquot of blue dye in each quadrant under the iris before putting in viscoelastic or the pupil ring.

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