As a beginning surgeon, the capsulorhexis is one of the hardest steps of cataract surgery to learn. The anterior capsule is fragile, thin (about 10 to 20 microns), and difficult to control. Once the capsule has been damaged, it cannot be undone as the tissue is unforgiving. The capsulorhexis is also critically important for the success of the case. The capsulorhexis maintains the capsule integrity during nucleus and cortex removal and it helps to hold the IOL optic securely in position. Remember that if the optic partially comes out of the capsular bag it can induce lens tilt which you will notice as an increase in overall refractive astigmatism despite the patient having little to no corneal astigmatism. In addition if the IOL optic moves anteriorly then the effective lens position changes and there will be a shift towards a myopic refraction. Finally, the capsulorhexis, together with the incision are part of your signature.
