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First Author: R.Pinto Coelho BRAZIL
Co Author(s): A. Messias J. Paula J. Neto
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Continuous curvilinear capsulorhexis (CCC) is a standard cataract surgery technique that offers many advantages 1 and is essential to safely perform a phacoemulsification procedure. A properly performed capsulorhexis enhances surgical safety, hydrodissection, cortical cleanup, and intraocular lens (IOL) centration and inhibits posterior capsule opacification. In the presence of common surgical risk factors, including a small pupil, a shallow anterior chamber, high vitreous pressure, weak zonules, pediatric eyes, and poor visibility, CCC may present challenges. Discontinuous capsulorhexis could extend around the equator into the posterior capsule, compromising the integrity of the capsular bag. Unfavorable consequences included vitreous loss, residual nucleus or cortex, and suboptimal IOL location and stability. Techniques describing how to perform the rescue have already been reported. We use a simple, reliable technique that permits rescue of CCC after radial extension.
Department of Ophthalmology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
After tear-out recognition, the surgeon should fill the anterior chamber with an ophthalmic viscosurgical device (OVD) to maximize anterior chamber depth. To rescue the capsulorhexis, the flap is pulled forward with a strong force applied in the plane of the anterior capsule and in the direction of the projected circular path of the finished capsulorhexis to redirect the tear centrally. This movement forces the rhexis to return to a curvilinear, continuous shape.
We performed 50 cases with this technique, within successfully in 47 cases of capsulorhexis rescue. Three cases were not conducive to return of the rhexis. In these cases, phacoemulsifications were performed using the low-parameter technique.
Discontinuous CCC complication remains potentially serious because the tear could extend around the equator into the posterior capsule, compromising the integrity of the capsular bag. Unfavorable consequences included vitreous loss, residual nucleus or cortex, and suboptimal IOL location and stability. Techniques used to avoid tear-out include direct puncture capsulorhexis, 2-stage capsulorhexis and diathermy probe. After the identification of tear-out, techniques that can be used for rescue including use of reversal of the force vector on the capsule flap, use of a 22-gauge needle or micro-forceps used in a counterclockwise direction, use of Tripan blue to find the leading edge of a lost lens . If these methods do not solve the problem and capsulorhexis stops at the zonular, rescue can be attempted through redirection to the desired with a quickly circumferential movement. Once the tear is rescued, the capsule flap is folded back over the anterior lens surface, and the CCC is continued according to the commonly used protocol.