In cases of dense white cataracts with fibrotic, leathery capsules, the standard continuous curvilinear capsulorhexis often fails because the tissue resists tearing. When a capsule is too scarred to follow a controlled path, surgeons can pivot to using micro-scissors to perform a “cut-and-pull” capsulotomy. After staining the capsule with trypan blue to improve visibility, a small incision is made with a cystotome or a 25-gauge needle. Using intraocular micro-scissors, our guest surgeon makes a series of radial or tangential snips to create a circular opening. This controlled cutting prevents a run-out radial tear caused by high intra-lenticular pressure. Although the resulting edge may not be as strong as a true capsulorhexis, the micro-scissors provide the precision necessary to navigate calcified plaques that would otherwise lead to potential complications.
