The Fibrotic Challenge: Vitrectorhexis
When you encounter a calcified or heavily fibrotic anterior capsule, your standard Utrata forceps will likely fail. You try to tear, but the tissue is scarred, leather-like, and refuses to follow the vectors of your shear force. If you pull too hard, you risk a radialized tear or, worse, zonular dehiscence.
In this video, we demonstrate the “nibbling” technique using the vitrector. By switching to the vitrectomy probe (set to a high cut rate and low aspiration), you can essentially “stamp out” a circular opening.
Key pearls for this case:
- Settings Matter: Use a high cut rate (at least 4,000+ CPM) to ensure clean edges without pulling on the zonules.
- OVD Support: Keep the anterior chamber deep with a cohesive OVD to maintain the working space.
- Edge Inspection: Ensure the margins are smooth; any small “nicks” can become the starting point for a wrap-around tear during phacoemulsification.
Don’t struggle with forceps when the tissue won’t cooperate. Use the tools at your disposal to ensure a controlled outcome. Have you used this technique? Share your experience in the comments below.
join me at His Master’s Voice Cataract & Refractive Meeting in Bengaluru, India from July 24 to 26, 2026. It will be great. Register here: https://nneyefoundation.org/hmv2026-reg/
