Preface

Phacoemulsification cataract surgery is one of the most frequently performed surgical procedures in the world. With advances in surgical techniques, the era of refractive cataract surgery has arrived. However, the surgeon should still focus on basic skills such as central continuous curvilinear capsulorhexis (CCC), phaco-chop techniques, and others. Moreover, specific challenging cases related to surgical techniques and surgical plan design, such as combining cataract surgery with microinvasive glaucoma surgery, cataract surgery in post-vitrectomized eyes, visual impairment caused by monovision surgical design, premium intraocular lens (IOL) implantation in cases of posterior capsule rupture and previous corneal refractive surgery, and capsular shrinkage syndrome of retinitis pigmentosa, should also be considered. The book also discusses issues of selecting candidates for IOL and pseudophakic presbyopia correction.

This book is fortunate to have outstanding contributors from different countries. We believe that the content of *Current Cataract Surgical Techniques* has a practical and clinical interest in clinical ophthalmology. Moreover, we hope that this book provides a timely answer to some current clinical needs.

> **Xiaogang Wang** Shanxi Eye Hospital, Taiyuan, China

**1**

Section 1

Basic Skills

Section 1 Basic Skills

**3**

precautions.

**Chapter 1**

*Liu Qian*

**Abstract**

**1. Introduction**

Continuous Curvilinear

Continuous curvilinear capsulorhexis (CCC) is an important step in of modern

Thomas Neuhann and Howard Gimbel, considered as pioneers in the development of the centered continuous curvilinear capsulorhexis (CCC) technique, first published their paper on the technique in 1990 [1]. The use of CCC technique makes the rim of the anterior capsule (AC) much stronger and decreases the risk of tearing, thus providing a solid foundation for applying the "chip and flip," "divide and conquer," "phaco chop," and "phaco pre-chop" techniques. What is more, the IOL could be more correctly positioned and stability with the centered continuous curvilinear anterior opening [2–5]. In terms of improving the prognosis, CCC technique could supply a continuous opening with more smooth edges [6]. The morphology of anterior capsule affect position of lens and refractive outcome greatly [7]. CCC helps maintain the intraocular lens (IOL) in the correct position and overlaped by anterior capsule as showed in **Figure 1** which providing a more predictable effective lens position (ELP) [6]. In addition, The CCC technique could reduce the incidence of posterior capsular opacification (PCO) [8–10]. With the current widespread-use of multi-focus intraocular lenses and astigmatism-correcting intraocular lenses, Cataract surgery has entered the refractive age. Centered CCC(CCCC) play a crucial role in obtaining good postoperative visual quality. Tilt and decentration of the IOL can decrease visual acuity which could result in astigmatism [11, 12]. Okada et al. [13] confirmed that decentration of optic center

phacoemulsification, which has crucial influence on the surgical process and prognosis. In this chapter, we mainly discuss following aspects: Preoperative preparation, Effects of incision on capsulorhexis, Capsulorhexis, Special cases of capsulorhexis and Capsulorhexis assisted by femtosecond laser. The problem need

to pay attention and the solution way in above aspects will be elaborated.

**Keywords:** continuous, circular, centered, capsulorhexis, cataract

by 0.4 mm could produce 0.25D change in spherical equivalent.

In this chapter, we will elaborate on several aspects include: preoperative preparation; the effects of incision on capsulorhexis. The two parts above mainly discuss the tools, head position of patient, exposure of surgical field of vision, red reflex of microscope, hand position of surgeon and importance of incision. Then capsulorhexis technique and special cases of capsulorhexis will be interpreted. In the end, we will introduce the advantage of femtosecond laser system in capsulorhexis and

Capsulorhexis
