The key to this case is making your capsulorhexis the normal size in 3 quadrants but then enlarging it to go around the anterior capsule defect in the last quadrant. This will prevent that weak area of the capsule from splitting and will allow 3 quadrants (270 degrees) of the capsulorhexis to overlap the IOL optic to ensure stability.
Creating a controlled capsulorhexis in the presence of a traumatic puncture to the anterior lens capsule requires careful planning and delicate technique. The tear created by the trauma may behave unpredictably, increasing the risk of uncontrolled radial extension during the capsulorhexis. The capsulorhexis should begin away from the site of the puncture, using forceps or a cystotome to create a gentle and circular opening. As the tear approaches the area of trauma, extra caution is needed to redirect the capsulorhexis margin around the defect (to encompass it) without allowing it to extend. Maintaining a slow and controlled maneuver helps prevent a runaway tear, preserving capsular integrity for safe lens removal and IOL implantation.
