Puncture, Aspirate, Extend, Lift And Pull Towards Centre (Paelptc) Method Of Continuous Curvilinear Capsulorrhexis In Intumescent Cataracts

To demonstrate safe way of performing continuous curvilinear  capsulorrhexis  in intumescent cataracts.

 72 cases of intumescent cataract were operated by single surgeon using Puncture, Aspirate, Extend, Lift, and Pull Towards Centre technique of capsulorrhexis between November 2019 and January 2023 

 After making side port and main phacoemulsification incisions, anterior capsule was stained with trypan blue in all the72 cases. Cohesive viscoelastic device was injected through main phaco incision with a  26 G canula to make the anterior capsule concave. Using 26G needle bevel up bent at 60degrees and mounted on 2 cc syringe anterior capsule was punctured and intralenticular fluid was aspirated. With same needle the capsulorrhexis was extended for approximately 2-2.5 mm. The needle was removed and a Haldipurkar capsulorrhexis  forceps was used to gently lift the capsulotomy edge and it was pulled towards the centre of nucleus creating 5-5.5mm continuous curvilinear capsulorrhexis.

Out of 72 capsulorrhexis  performed with Puncture, Aspirate, Extend, Lift, and Pull Towards Centre technique of capsulorrhexis  (PAELPTC) only 2 extended towards periphery which were again reconstructed by injecting more cohesive viscoelastic device and pulling the edge of capsulorrhexis  towards centre resulting in oval shaped capsulotomies in these two cases. Non of the capsulorrhexis  extended towards equator.  

Intumescent cataract pose a challenge to surgeons while doing capsulorrhexis and many times the capsulorrhexis extend towards periphery and sometimes to the equator. In this technique out of 72 continuous curvilinear  capsulorrhexis , none of the capsulorrhexis  extended towards equator and only two extended towards periphery. From the results we can conclude that PALPTC is safe way of doing continuous curvilinear capsulorrhexis  in intumescent cataracts achieving  97% successes in performing continuous curvilinear  capsulorrhexis.