Anterior Capsule Tears
A continuous curvilinear capsulorrhexis (CCC) is an integral step in phacoemulsification surgery (see Chapter 8). Any discontinuity in the CCC can complicate the remainder of the phacoemulsification procedure. Occasionally during a CCC, the capsulorrhexis (also spelled capsulorhexis) may extend toward the periphery (ie, larger than the intended diameter). A “Little maneuver” can be used to rescue an errant anterior capsulorrhexis in such cases (see Video 10-6 and sidebar).
Little capsulorrhexis rescue maneuver. Courtesy of Tom Oetting, MD; The University of Iowa.
If it is not possible to complete the CCC, several options are available; these maneuvers can be facilitated with intraocular scissors, microforceps, and the generous use of OVDs to maintain a fully deep anterior chamber. One option would be to create a second tear with a cystotome near the origin of the first tear and extend it in the opposite direction until it “meets up” with the original tear. Another option would be to convert to a “can-opener” capsulotomy (see the Appendix).
Other causes of anterior capsule tears may occur during surgery. In eyes with white intumescent cataracts, the anterior capsule may suddenly split, creating an “Argentinian flag sign” in capsules that have been stained with trypan blue (see Chapter 12). During a femtosecond laser capsulotomy, a radial tear may occur if a complete capsulotomy is not created before removing the capsule remnant. During phacoemulsification, contact of the phaco tip with the capsule may result in a tear in the capsule. In eyes with a discontinuous capsulorrhexis, care must be taken during each subsequent step of the surgery to make sure that the anterior capsule tear is not extended to the posterior capsule, because of the higher risk of vitreous loss and retained lens fragments (see the sidebar Interventions for a Discontinuous Capsulorrhexis). If extension past the equator to the posterior capsule does occur, it should be managed as a capsule rupture (see the sidebar Management of Posterior Capsule Rupture later in this chapter).
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.