For a white cataract, particularly a pressurized and intumescent white cataract, the double capsulorhexis technique is very helpful to avoid capsular run-out and the dreaded Argentinian Flag Sign. In this case a senior resident with about 50 cases under her belt is performing cataract surgery for a patient with a white cataract. Using just a cystotome via a paracentesis incision, a small initial capsulorhexis is created and the nucleus is rocked to allow for egress of liquefied lens cortex material. This is done while the anterior chamber is pressurized with viscoelastic so that the pressure in the AC is higher than the pressure within the capsular bag. All of this is done prior to making the main incision with the keratome because that larger phaco incision will not allow us to sufficiently pressurize the anterior chamber due to viscoelastic leakage.
click to learn from this resident case (at 3x speed) using the double rhexis technique: