3089: white cataract capsulorhexis x 10
One of these 10 cases ends up in a run-out capsulorhexis – see if you can guess which one!
Making the capsulorhexis in white cataracts demands constant vigilance, as deceptively calm tear vectors can rapidly run out toward the equatorial zonules under elevated intumescent pressure giving you the dreaded Argentinian Flag Sign. Analyzing multiple sequential white cataract tears highlights how variable cortical liquification and central convex distension destabilize capsular mechanics, making initial puncture and vector control variable. To prevent radial extension and secure a continuous loop, the surgeon must maintain ophthalmic viscosurgical device pressurization, stain the anterior capsule thoroughly with trypan blue, and apply frequent regrasping maneuvers close to the tearing apex. If the tear begins propagating outward toward the periphery, applying direct centripetal force using the Little technique or redirecting from an adjacent micro-puncture restores control before completing the anterior capsulotomy. Watch the video to study 10 consecutive white cataract capsulorhexes and learn how to recognize and correct subtle tear run-outs in high-pressure eyes. What surgical adjustment or tool do you rely on most when a white cataract tear starts radiating toward the periphery? Please comment your thoughts below.
