3039: convert to a can-opener capsulotomy
When encountering a run-out capsulorhexis that threatens to extend posteriorly into the zonules, converting to a controlled can-opener capsulotomy is often the safest bailout option to preserve anterior segment stability. Rather than continuing to apply radial tension on a compromised tear path, which risks wrapping around the equatorial lens margin, using a cystotome to create a series of small, closely spaced punctures allows you to safely complete the anterior opening. While a can-opener opening lacks the strength of a continuous curvilinear capsulorhexis, it effectively halts the uncontrolled vector run-out and permits controlled hydrodissection and nuclear disassembly. Watch the video to analyze the step-by-step conversion technique and see how to manage nuclear delivery without propagating the radial tear. How do you manage a capsulorhexis tear that runs out toward the periphery during intumescent or difficult cases? Please comment your pearls below.
