**4.4 Capsulorhexis technique**

The limbus can be used as reference to guide the capsulorhexis [20]. For the unexperienced surgeon, the technique is difficult given the narrow diameter of 5–5.5 mm. To aid the process, the marks on forceps in **Figure 6** or the marks made on the cornea before initiation of capsulorhexis, can be used for guidance. The following points should be considered during capsulorhexis:

a.If excessive pressure is applied by the forceps on the internal incision, the viscoelastic agent could spill out from the incision site. This would leave the

#### **Figure 20.**

*The light spot (red cirlce) would be center of capsule if the position of head and eye maintain level. The radius of capsulorhexis is showed as red arrow.*

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

anterior chamber partially filled, and the resulting unbalanced forces applied

*The force of capsulorhexis is composed of forces in two direction as showed by red arrows. One is along the* 

b.The trajectory of the capsulorhexis will depend on the balance of two forces exerted during the movement of the forceps by the surgeon, as shown in **Figure 21** by red arrows. One is the tearing force along the tangent of the circle, and the other is the pulling force perpendicular to the tangent, towards the center of the circle. Only when the two forces are balanced, will the trajectory be correct and the capsulorhexis completed successfully. If the tearing force along the tangent of the circle is larger, the trajectory of the capsulorhexis would shift laterally, causing a tear. If the pulling force is larger, the trajectory of capsulorhexis would deviate towards the center, resulting in a very small

c.A skilled surgeon can complete the capsulotomy in 3 to 4 attempts, while a beginner should increase the number of attempts and stop before the capsule trajectory cannot be controlled. Extra care should be taken at the joint, and an

d.During the movement, avoid lifting the forceps too high, to avoid scratching

Congenital cataracts in children can be a challenge for surgeons, and should not

forceps. The discission needle made by 1 ml syringe is the preferred instrument

a.The AC of children is more flexible, which makes it difficult to cut with

additional capsulotomy may be added if necessary.

on the AC, will cause capsulorhexis failure.

*tangent of the circle, and the other is towards the center of the circle.*

capsulorhexis.

**Figure 21.**

the corneal endothelium.

**5. Special cases of capsulorhexis**

be attempted by beginners, for several reasons:

in this case, as shown in **Figure 22**.

**5.1 Capsulorhexis in children**

#### **Figure 21.**

*Current Cataract Surgical Techniques*

**4. Capsulorhexis**

**4.1 Viscoelastic injection**

the suspensory ligament.

**4.2 Bimanual coordination**

cornea, which affects the surgical field of vision.

an outward radius of approximately 2.5 mm.

**4.3 The production of the lamella**

**4.4 Capsulorhexis technique**

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**Figure 20.**

*of capsulorhexis is showed as red arrow.*

*The light spot (red cirlce) would be center of capsule if the position of head and eye maintain level. The radius* 

When a viscoelastic agent is injected into the eye, the needle should move inside out, while filling the whole anterior chamber with the viscoelastic to flatten the AC. Otherwise, the path of the capsulorhexis would slide in the direction of

Coordinate your hands, hold the tweezers in your dominant hand and slightly

The process of capsulorhexis is equivalent to drawing a circle. With the eye in position, consider the focal point reflected by the microscope light as the center, and tear the forceps from this point (red circle in **Figure 20**) to open the AC, with

The limbus can be used as reference to guide the capsulorhexis [20]. For the unexperienced surgeon, the technique is difficult given the narrow diameter of 5–5.5 mm. To aid the process, the marks on forceps in **Figure 6** or the marks made

a.If excessive pressure is applied by the forceps on the internal incision, the viscoelastic agent could spill out from the incision site. This would leave the

on the cornea before initiation of capsulorhexis, can be used for guidance. The following points should be considered during capsulorhexis:

fixate the eyeball to maintain the cornea in the middle. The hand holding the tweezers should be soft and not put pressure on the eyes. Otherwise, the viscoelastic agent can extrude from the incision, resulting in uneven force on the AC and capsular tear. However, too much pressure on the eyeball will cause folds on the

> *The force of capsulorhexis is composed of forces in two direction as showed by red arrows. One is along the tangent of the circle, and the other is towards the center of the circle.*

anterior chamber partially filled, and the resulting unbalanced forces applied on the AC, will cause capsulorhexis failure.

