Two-step capsulorrhexis technique allows for safer phaco with hard cataracts

BUENOS AIRES — A two-step capsulorrhexis allows for safer preparation for phacoemulsification when approaching a hard cataract, a surgeon said here.

Arup Chakrabarti

Speaking at the All-India Ophthalmological Society session at the Argentinean Society of Ophthalmology Annual Course, Arup Chakrabarti, MS, showed a technique that he devised.

"The most difficult situation in these cataracts is the capsulorrhexis. There is hardly any visibility," he said. "Once the capsulorrhexis in a white cataract situation is done, half the job is done. Subsequently, the surgery should go on extremely well."

With the advent of various dyes, Dr. Chakrabarti said this process has become easier.

The first step, Dr. Chakrabarti said, is to perform a small 3-mm to 4-mm capsulorrhexis to allow for its natural move toward the periphery. This allows for easy retrieval for the surgeon, he explained.

"If you feel this rhexis size is not adequate for you to get good phacoemulsification in a hard cataract ... we can perform a two-step rhexis," he said.

In the creation of the second capsulorrhexis, Dr. Chakrabarti showed that he decompresses the capsular bag, removes as much material as possible and re-inflates the bag before performing an additional capsulorrhexis to the necessary size and shape.

"If there is pressure and the cataract is swollen, then I think it is not safe to make a one-step rhexis," he said. "If I try to make a 5-mm rhexis in a cataract that is really swollen, I am taking a lot of risk. If I tend to go to the periphery ... it's very difficult to get it back to the center, whereas if I'm making a 3-mm rhexis, it can tend toward the periphery and still it is in the safe zone."