Flap Motility Sign, A Good Indicator Of Peripheral Extension Of Capsulorhexis During Phacoemulsification.

To assist the surgeon in knowing whether an accidental peripheral extension during capsulorhexis reached the equator or not; and based on, the surgeon can proceed phacoemulsification or convert to an extracapsular or small incesion cataract surgery.

Magrabi Eye and Ear Hospitals and Centres 

Jeddah,Makkah, Saudi Arabia.

Three cases of white cataract were operated and there was a peripheral extension during capsulorhrexis in all of them. Decompressing the lens pressure after staining the anterior capsule with trypan blue was done . Unknown end peripheral extension was happened while enlarging the capsulorhrexis which was retrieved after creating a snip using a microssisor. Now , there is a good sized capsulorhrexis with unclear extension, pre-equator or post-equator ? I followed the peripheral extended flap motility which was fluttering and everted all the time of surgery which indicate a pre-equator extension and I complete the phacoemulsification successfully with intact posterior capsule by the end of surgery .

All those three cases were done eventually despite of peripheral extension . The flap was fluttering and everted in all those cases and there weren't posterior capsule extention by the end of the surgery which means the peripheral extension was pre-equator .

post-operatively , the corneas were clear with stable intraocular lens and normal intraocular pressure. all patients were happy with their vision improvements.

Peripheral extension during the capsulorhexis of white cataract is not uncommon . Flap motility sign can help cataract surgeon in making right  immediate decision . When the flap is fluttering and everted , the extension is pre-equator and the surgeon can proceed phacoemulsification. However, if the flap is not fluttering and inverted , the extension is post-equator and the surgeon can convert int extracapsular or small incesion cataract surgery which are more safe for patient.