**2.2 Patient's head position**

The position of the head is vital to ensure the centrality of the AC opening. The patient's head should be kept horizontal for the lens plane to remain horizontal

**Figure 4.** *Calladine-Inamura Capsulorhexis forceps. Hinge design on the forearm in a and the detail in B.*

(**Figure 7**). The AC opening could be decentered downwards if the jaw is too elevated (**Figure 8**), or upwards if the forehead is too elevated (**Figure 9**).

**Figure 5.** *Ikeda MICS Capsulorhexis forceps. Tube design without joint in A and the detail of tip in B.*

**Figure 6.**

*The scaleis marked on the tip of forceps as scratches. The distal one is 2.5 mm, the proximal is 5 mm.*

**7**

*Continuous Curvilinear Capsulorhexis DOI: http://dx.doi.org/10.5772/intechopen.96556*

**2.3 Surgical field of vision**

**Figure 8.**

**Figure 9.**

the pupil greater than 6.0 mm.

I-Ring pupil expander etc., can be used in clinic.

using Vannas capsulotomy scissors, as shown in **Figure 13**.

*The AC opening would be decentered towards inferior if the jaw is too elevated.*

The pupils must be fully dilated to expose the surgical field. One drop of 0.5%tropicamide is instilled every 15 min (four times), to maintain the diameter of

*The AC opening would be decentered towards superior if the forehead is too elevated.*

The rare cases in which cataracts are complicated with uveitis, the pupil cannot be dilated adequately because the iris is atrophic and inelastic. In such cases, the pupil can be stretched by two choppers, as shown in **Figure 10**, which is known as the pupil-stretch technique. Moreover, alternative devices and techniques are available. For example the iris can be fixed by iris hooks through a series of side-incisions to dilate the pupil (**Figure 11**), and the use of the Malyugin ring can reduce the number of side incisions required (**Figure 12**). There are also many other pupil expansion devices, such as Hydro view Iris Protector Ring, B-HEX Pupil Expander,

However, the use of instruments or pupil-stretch technique can lead to tears of the iris muscle fiber, resulting in pupil malformation and even the risk of hemorrhage as show in **Figure 10** (red arrow). In such cases, coreoplasty can be performed

Moreover, when the pupillary area of chronic uveitis is adhered to the AC by an exudative membrane, capsulorhexis forceps could be used to dilacerate the

*Continuous Curvilinear Capsulorhexis DOI: http://dx.doi.org/10.5772/intechopen.96556*

#### **Figure 8.**

*Current Cataract Surgical Techniques*

(**Figure 9**).

**Figure 5.**

(**Figure 7**). The AC opening could be decentered downwards if the jaw is too elevated (**Figure 8**), or upwards if the forehead is too elevated

*Ikeda MICS Capsulorhexis forceps. Tube design without joint in A and the detail of tip in B.*

**6**

**Figure 7.**

**Figure 6.**

*The plane of the lens should be kept level by adjusting the position of head before operation.*

*The scaleis marked on the tip of forceps as scratches. The distal one is 2.5 mm, the proximal is 5 mm.*

**Figure 9.**

*The AC opening would be decentered towards superior if the forehead is too elevated.*

#### **2.3 Surgical field of vision**

The pupils must be fully dilated to expose the surgical field. One drop of 0.5%tropicamide is instilled every 15 min (four times), to maintain the diameter of the pupil greater than 6.0 mm.

The rare cases in which cataracts are complicated with uveitis, the pupil cannot be dilated adequately because the iris is atrophic and inelastic. In such cases, the pupil can be stretched by two choppers, as shown in **Figure 10**, which is known as the pupil-stretch technique. Moreover, alternative devices and techniques are available. For example the iris can be fixed by iris hooks through a series of side-incisions to dilate the pupil (**Figure 11**), and the use of the Malyugin ring can reduce the number of side incisions required (**Figure 12**). There are also many other pupil expansion devices, such as Hydro view Iris Protector Ring, B-HEX Pupil Expander, I-Ring pupil expander etc., can be used in clinic.

However, the use of instruments or pupil-stretch technique can lead to tears of the iris muscle fiber, resulting in pupil malformation and even the risk of hemorrhage as show in **Figure 10** (red arrow). In such cases, coreoplasty can be performed using Vannas capsulotomy scissors, as shown in **Figure 13**.

Moreover, when the pupillary area of chronic uveitis is adhered to the AC by an exudative membrane, capsulorhexis forceps could be used to dilacerate the

*To stretch the pupil in the opposite direction (white arrow) with two chopping hook. The relevant side-effect are hemorrhage (red arrow) and tansformation of pupil after operation.*

#### **Figure 11.**

*Iris hooks to fix the iris through side incision which is composed of a hook (red arrow) and gasket (white arrow).*

membrane (**Figure 14**). After both these procedures, the pupils can be dilated injection of a viscoelastic agent.

#### **2.4 Red reflex during surgery**

The red reflex test, which is performed using a microscope, is very important at each step of cataract surgery. It allows the surgeon to clearly see the capsulorhexis path by illuminating the AC (white arrow in **Figure 15**), and visualization of the path can be enhanced by adjusting the ratio of coaxial to paraxial light on the microscope (**Figure 16**).

In cases of mature or hyper mature cataracts, the light reflects off the posterior segment, generating a retro-illumination of the AC, which is insufficient for correctly performing capsulorhexis. In such cases, Trypan blue dye could be used to stain the AC.

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**Figure 14.**

*Continuous Curvilinear Capsulorhexis DOI: http://dx.doi.org/10.5772/intechopen.96556*

*Malyugin ring after disinfection and sealing is showed in A. Malyugin ring stretch the pupil during operation* 

*Coreoplastyis applied by capsulotomy Vannas scissors to amplify the vision field.*

*Capsulorhexis forceps is used to tear the membranes to remove its restriction on the pupil.*

**Figure 12.**

**Figure 13.**

*as showed in B (red arrow).*

#### **Figure 12.**

*Current Cataract Surgical Techniques*

membrane (**Figure 14**). After both these procedures, the pupils can be dilated injec-

*To stretch the pupil in the opposite direction (white arrow) with two chopping hook. The relevant side-effect* 

*are hemorrhage (red arrow) and tansformation of pupil after operation.*

*Iris hooks to fix the iris through side incision which is composed of a hook (red arrow) and gasket* 

The red reflex test, which is performed using a microscope, is very important at each step of cataract surgery. It allows the surgeon to clearly see the capsulorhexis path by illuminating the AC (white arrow in **Figure 15**), and visualization of the path can be enhanced by adjusting the ratio of coaxial to paraxial light on the

In cases of mature or hyper mature cataracts, the light reflects off the posterior segment, generating a retro-illumination of the AC, which is insufficient for correctly performing capsulorhexis. In such cases, Trypan blue dye could be used to

**8**

stain the AC.

**Figure 11.**

**Figure 10.**

*(white arrow).*

tion of a viscoelastic agent.

microscope (**Figure 16**).

**2.4 Red reflex during surgery**

*Malyugin ring after disinfection and sealing is showed in A. Malyugin ring stretch the pupil during operation as showed in B (red arrow).*

**Figure 13.**

*Coreoplastyis applied by capsulotomy Vannas scissors to amplify the vision field.*

**Figure 15.** *Capsulorhexis path is clear with good red reflex (white arrow).*

**Figure 16.** *Coaxial light and paraxial lights on the operation microscope.*
