1345: capsulorhexis split – now what?

This patient has a white cataract and this resident is able to perform a successful capsulorhexis after staining with trypan blue dye. However, the anterior capsular rim ends up splitting during hydro-dissection. The challenge is that the white cataract is so opaque that we cannot see the fluid wave from hydro-dissection. We must use other clues such as the nucleus moving slightly more anterior or the capsulorhexis stretching as the nucleus pushes up against it. In some white cataracts, the cortex has liquefied enough that the nucleus will rotate without hydro-dissection. In this case a bit too much hydro-dissection was done and then we see the sudden ‘snap sign’ where the built up pressure in the capsular bag gets released as the capsule breaks. Fortunately, in this case it was just an anterior capsular rim split, but it could have been the posterior capsule too. The challenge now is to finish this case without allowing the anterior capsular split to extend.

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