Cutting Through the Resistance: Micro-Scissors Rhexis
When the anterior capsule is so heavily fibrotic or calcified that it behaves more like cardboard than tissue, even your best forceps won’t suffice. If the tissue doesn’t tear, you must cut. This video highlights the precision of using micro-scissors to manually create a controlled capsulotomy in the toughest of eyes.
By utilizing multiple paracentesis incisions, we can approach the fibrotic plaque from different angles, ensuring we maintain a curvilinear shape. This “snip-by-snip” method allows you to ignore the traditional physics of tearing and instead focus on the geometry of the opening.
Key pearls for this approach:
- Avenues of Access: Don’t hesitate to make an extra paracentesis. Proper ergonomics are essential to prevent “tugging” on the zonules.
- The “Tag” Team: Use micro-forceps in your non-dominant hand to provide counter-traction while the scissors make the cut.
- Smooth Margins: Aim for small, overlapping snips. Any jagged “V” shape is a potential stress point for a radial run-out during nucleus manipulation.
When the capsule won’t follow your lead, take control with a sharp edge. Have you used this technique? Please comment below.
