Flap Motility Sign in a Peripheral Capsular Tear

The challenge of phacoemulsification of intumescent cataract is the high incidence of peripheral extension during  capsulorhexis. The question in these cases is whether this a pre-equatorial or postequatorial extension. Should we continue phacoemulsification or convert to ECCE? In this case, Dr. Khaled Hassan followed the movement of the peripheral extension flap (or flap motility sign). In this case of dense cataract, the flap motility was everted and fluttering, the extension was pre-equatorial, and the surgery was successful. Another important tip in these cases is to fill the anterior chamber with OVD before taking the phaco probe or irrigation probe out of the anterior chamber to prevent anterior chamber (AC) collapse and to maintain the AC pressure. The IOL should be implanted in the bag with haptics perpendicular to the direction of extension.