**5.1 Capsulorhexis in children**

Congenital cataracts in children can be a challenge for surgeons, and should not be attempted by beginners, for several reasons:

a.The AC of children is more flexible, which makes it difficult to cut with forceps. The discission needle made by 1 ml syringe is the preferred instrument in this case, as shown in **Figure 22**.

#### **Figure 22.**

*A showed the discission needle made by 1 ml syringe. B showed the detail of the needle.*


## **5.2 Uveitis complicated cataract**

The challenge in this situation is the difficulty of pupil dilation due to iris degeneration caused by uveitis, which has a significant impact on the surgical field of vision. The measures recommended for this situation have been already mentioned in the **surgical field of vision** section.

### **5.3 Mature cataract**

In mature cataracts, the capsular membrane is relatively brittle and often accompanied by intumescent lens, as shown in **Figure 23**.

Due to the excessive expansion of the surface, the AC often tears-out, forming the Argentinian flag sign. To avoid this, the method of capsule decompression is recommended as follows:

**15**

**Figure 24.**

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

**Figure 24**.

a.Dye the capsule with Trypan blue to increase visibility

A blunt needle can then be used to clear this efflux.

extending the radius to approximately 2.5 mm.

**5.4 The challenge of small pupil and flabby suspensory ligament**

b.Puncture the central area of the AC with the tip of a needle or forceps as A in **Figure 24**, with a resulting liquefied cortical efflux (red arrow in B of **Figure 24**).

c.Alternatively a discission needle can be used to puncture the AC and then clear the liquefied cortex under the AC directly. Remember to bevel the needle downwards and to maintain the operation in the central area of the AC as C in

d.When the liquefied cortex is cleared, the central area of the AC will collapse (D in **Figure 24**). At this point, the AC can be flattened by injection of viscoelastic, and capsulorhexis initiated. The process of capsulorhexis could be then divided into two steps as needed, beginning with a small opening, and the then

A disease that often causes difficulty with capsulorhexis is exfoliation syndrome,

because of two clinical aspects. Firstly, the pupils cannot be dilated past 5 mm,

*Decompression of intumescen lens. To pierce the intumescent AC with the tip of capsulorhexis forceps (A). The liquefied cortex spills out (red arrows in B). Discission needle was applied to clear the liquefied cortex beneath* 

*AC (C). AC collapse appeared as larger annular reflections (D).*

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

*Current Cataract Surgical Techniques*

**5.2 Uveitis complicated cataract**

in the **surgical field of vision** section.

panied by intumescent lens, as shown in **Figure 23**.

**5.3 Mature cataract**

**Figure 22.**

recommended as follows:

**14**

**Figure 23.**

*Color photo of white cataract with intumescent lens and shallow anterior chamber.*

b.Owing to the increased toughness and flexibility of the AC, the trajectory of capsulorhexis can be difficult to control. The pulling force should be slightly

c.Cataracts with congenital lens abnormality are usually associated with suspensory ligament anomaly, which can be a challenge even for a skilled operator.

The challenge in this situation is the difficulty of pupil dilation due to iris degeneration caused by uveitis, which has a significant impact on the surgical field of vision. The measures recommended for this situation have been already mentioned

In mature cataracts, the capsular membrane is relatively brittle and often accom-

Due to the excessive expansion of the surface, the AC often tears-out, forming the Argentinian flag sign. To avoid this, the method of capsule decompression is

increased to avoid tearing and an oversized opening.

*A showed the discission needle made by 1 ml syringe. B showed the detail of the needle.*

