Ten Tips to Achieve a Complete Curvilinear Capsulorhexis

1. See clearly: Focus the microscope in such a way that the anterior capsule is exactly in focus. Low magnification would help in increasing depth perception, even though things don’t appear grossly magnified. Even if the patient moves the eye a little, things don’t go out of focus.

2. Stain if needed: If the red glow is not very clearly seen, and the cut end of the anterior capsular flap may not be easily visible, its best to stain the capsule by trypan blue. This should be done before starting the capsulorhexis.

3. The pressure above should be more than the pressure below. The capsulorhexis flap shall not extend to the periphery if the pressure above it is more than the pressure below it. If superior rectus muscle suture has been taken, loosen it. Loosen a tight speculum. Both increase the pressure on the globe, pushing the vitreous up and putting strain on the posterior capsule.

4. Do CCC slowly: The time spent on it is completely worth it. The success of surgery, especially in phacoemulsification, and subsequent intra-ocular lens implantation depend on a good capsulorhexis. People spend money on Zepto and Femto for getting a good capsulorhexis. A few minutes extra can be the difference between an intact and broken CCC.

5. Watch for external extension: If the flap is running to the periphery, control it.

6. Do 15-30 degrees at a time: The chances of run-away or extension are more in a hurriedly performed capsulorhexis. Change the placement of the cystitome or Utrata forceps frequently. They should grasp the flap nearest to the cut end.

7. Finish outside in the chances of extension or run away are zero if this is done.

8. Plan size depending on the surgery: Manual small incision cataract surgery needs large capsulorhexis, especially if the nucleus is very hard, like in a brunescent or black (nigra) cataract. Multifocal and toric IOLs need smaller capsulotomy to ensure exact centration. Smaller CCC is planned in posterior capsular or posterior polar cataract, where chances of posterior capsular rent are higher, and IOL may have to be implanted on the anterior capsular rim.

9. Complete more important than curvilinear or circular: The shape is not very important, having an intact rim is.

10. Polish at the anterior capsular rim in the end: The lenticular cells are present at the equator and the periphery of the anterior capsule. Polishing them ensures that the capsules stay transparent for many years to come.

Dr. Parikshit Gogate

Dr. Parikshit Gogate has done his MBBS from B.J. Medical (PuneUniversity) in 1992, M.S. (Ophth) with gold medal(1stamongst all medical post-graduates in Shivaji University) from Govt. Medical College, Miraj in 1997, DNB (Ophth) in 1998; FRCS from Royal College of Surgeons, Edinburg and MSc (Community Eye Health) with distinction from International Centre for Eye Health, Institute of Ophthalmology (Associated with Moorfields Eye Hospital), University College, London, UK in 2001. He had secured 55th All India rank in Civil Services 2000 exam, attended the Foundation course at Lal Bahadur Shastri National Academy of Admisnistration, Mussoorie, for IPS (Gujrat). He worked with Poona Blind Mens Association & H.V.Desai Eye Hospital from 1998-2009, heading the pediatric ophthalmology & community ophthalmology departements and briefly as the medical director. He was a Visiting faculty, African Vision Research Institute, Durban, South Africa (2012-2017) and ICARE, L.V.Prasad Eye Institute, Hyderabad (2002-15). Honorary Lecturer, School of Medicine, Dentistry and Biomedical Engineering, Queens University, Belfast, United Kingdom (2020-23). He is presently in private practice since 2010, Trustee of Community Eye Care Foundation, Pune; Faculty at D.Y.Patil Medical College, Pimpri since June 2012and the Medical Director of Atharva Netralaya Pvt Ltd, a group practice, since May 2013. He has 90 papers in peer-reviewed journals with interest in cataract surgery, community eye health; paediatric ophthalmology, training and research. He has been Invited to teach/ speak on cataract surgery in Abu Dhabi, China, USA, UK, Oman, Ethiopia, Uganda, Germany, Cameroon, Malayasia, Indonesia, Spain, Mongolia, Zambia, Egypt and Pakistan and about pediatric ophthalmology in Dubai, Brazil, Sri Lanka, Kenya, Syria, Oman, Cambodia, Nepal, Mexico, Bangladesh, Zambia, Japan, Saudia Arabia, Singapore, South Africa and Tanzania. Parikshit is married to Bageshri, a Professor of Pathology and is an avid philatelist, numismatist, reader, mountaineer and traveler.

Ten Tips to Achieve a Complete Curvilinear Capsulorhexis

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