Sometimes with white cataracts, it can be difficult to notice subtle signs during the pre-operative exam and consultation. In this case, the capsule looked fine until the patient was on the operating room table and trypan blue dye was instilled. Now you can see extensive wrinkles and fibrosis of the anterior lens capsule. How would you perform the capsulorhexis in this case? What are the challenges and risks? What is the secret to success?
That very aggressive “Little Maneuver” at around 1:03 was a “do or die” play that won’t always work in your favor. Could easily have torn out there. I prefer in these cases to use a 2 handed technique and to stabilize the other side that I am pulling against with a microforceps. One can use 2 microforceps coming through a paracentesis to keep the anterior chamber better pressurized and to provide countertraction. Should always add some viscoelastic prior to doing the “Little Maneuver” to flatten the anterior capsule ….especially as one is running out to the periphery. If things are getting away from you can start tearing from the other direction.