Combating difficult capsulorhexis in white cataracts using strip capsulorhexis technique

Background: Capsulorhexis in mature white cataracts has long been recognized as a tough task to conquer. [1] In this type of cataract, generally, the capsule tends to be thin. Further, due to the absence of red reflex, there is difficult visualization of the capsule edge during the surgery. [2] There is also a tendency for the anterior capsule tear to extend toward the periphery, leading to the dreaded Argentinian flag sign after the swollen lens is punctured. [3] The continuous curvilinear capsulorhexis (CCC) forms the backbone of modern-day phacoemulsification surgery, where 'in-the-bag' intraocular lens implantation (IOL) is targeted in all patients. Purpose: We present a novice technique of achieving CCC in white intumescent cataracts. Synopsis: All the patients with white/intumescent cataracts are operated under peribulbar/topical anaesthesia. After placement of a wire speculum, corneal incision is made using a 2.2 mm keratome. Two paracentesis of 1.2 mm each, 2 clock hours away from the main incision, are made. Staining of the anterior lens capsule is done with trypan blue under air. This is followed by injection of viscoelastic to maintain the anterior chamber. A base-in-nick with the help of 27 G needle is given in the anterior capsule, followed by decompression of the capsular bag by aspiration of the fluid. The nicked part of the lens capsule is then grabbed by capsulorhexis forceps, and a strip of about 3–4 mm is fashioned in a horizontal direction, leaving a rectangular opening in the capsule. Further irrigation of the milky fluid is carried out, followed by hydrodissection and rotation of the nucleus. After this, a rhexis scissor is used to cut one end of the strip rhexis that was made earlier, and using the capsulorhexis forceps, the CCC is then rounded off. After completion of CCC, phacoemulsification is carried out, and in-the-bag placement of IOL is done. Highlights: Base-in nick in the anterior capsule followed by making the horizontal strip. Video link: https://youtu.be/K9-al72XNZg