1579: phaco through small capsulorhexis

The double capsulorhexis technique is very useful for intumescent white cataracts because it allows us to safely decompress the capsular bag to prevent the Argentinian Flag Sign. In most of the cases where I perform this technique, I prefer to enlarge the capsulorhexis (performing the second capsulorhexis) after the capsular bag has been depressurized but before I begin nucleus removal and this is the way that I have taught it to residents as well. In today’s video, our guest surgeon does something more challenging: he removes the entire cataract through the small initial capsulorhexis which has a diameter of 3.5 mm and then he enlarges the capsulorhexis after the IOL has been implanted.

This technique works very well in his hands, but if you’re a beginner surgeon I do not recommend it. The challenge is that the cataract which has a diameter of about 9 mm needs to be broken into many small pieces within the capsular bag so that each of these can be extracted through the 3.5 mm diameter capsulorhexis. This surgery is very enjoyable to watch and I commend Dr Tadanki on his excellent skills.

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