2968: Challenging Capsulorhexis white double rhexis
A double rhexis technique is a vital safety maneuver when managing a tense white cataract. The primary challenge is the elevated intralenticular pressure, which drastically increases the risk of an unprompted posterior capsule rupture—the dreaded Argentinian Flag Sign. The procedure begins by creating a small, controlled central capsulorhexis (about 2.5 to 3.0 mm) under a dense cohesive ophthalmic viscosurgical device (OVD) to maintain anterior chamber stability. Once this initial opening is secure, a bimanual I/A handpiece or a needle cannula is used to thoroughly aspirate the pressurized, milky cortical milk from the anterior lens capsular bag, effectively decompressing the lens complex. With the pressure equalized and the capsular tension relieved, a second pass is performed. The initial opening is carefully enlarged to a robust 5.0 to 5.5 mm diameter, ensuring a secure, clean edge that easily withstands phaco and safe IOL placement.
