Introduction:

Capsulorhexis is a critical step in modern cataract surgery, involving the creation of a circular and continuous opening in the anterior lens capsule. This article aims to provide a comprehensive understanding of the capsulorhexis technique, its importance, variations, and the challenges associated with mastering this essential skill.

Importance of Capsulorhexis:

Capsulorhexis is a crucial step in cataract surgery as it serves several essential functions:

• Lens Aspiration Access: Capsulorhexis provides a controlled and safe access point for lens aspiration, allowing for the removal of the cataractous lens.
• IOL Stability: A well-centered and appropriately sized capsulorhexis is essential for optimal IOL positioning and stability within the capsular bag.
• Posterior Capsule Integrity: A properly sized capsulorhexis helps maintain the integrity of the posterior capsule, reducing the risk of posterior capsule rupture.

Technique:

The capsulorhexis technique involves the following steps:

• Incision: A small corneal incision is made to access the anterior chamber of the eye.
• Viscoelastic Injection: A viscoelastic substance is injected into the anterior chamber to maintain space and protect the corneal endothelium.
• Anterior Capsulotomy: Using a sharp-edged bent needle or capsulorhexis forceps, a small opening is made in the anterior capsule, creating a flap-like edge.
• Continuous Curvilinear Capsulorhexis (CCC): The flap is then gently extended in a continuous circular fashion, following the natural curvature of the lens, until a well-centered and appropriately sized capsulorhexis is achieved.
• Viscoelastic Removal: Excess viscoelastic is removed, and the capsular bag is filled with a cohesive viscoelastic to maintain space during IOL insertion.
• Lens Aspiration and IOL Insertion: The cataractous lens is aspirated, and an intraocular lens (IOL) is carefully inserted into the capsular bag.

Variations and Challenges:

Several variations of the capsulorhexis technique have been described, including the use of femtosecond lasers for precision and consistency. However, manual capsulorhexis remains the gold standard for many surgeons due to its proven efficacy.

Mastering capsulorhexis can be challenging, especially for novice surgeons, as it requires precise control of the capsulorhexis forceps, a steady hand, and an understanding of intraocular dynamics. Complications associated with capsulorhexis include incomplete or irregular openings, radial tears, and capsular block syndrome.

Conclusion:

Capsulorhexis is a fundamental step in cataract surgery that significantly impacts surgical outcomes. Surgeons must aim for a well-centered, appropriately sized, and continuous capsulorhexis to ensure proper IOL stability and visual rehabilitation. Continuous practice and a deep understanding of the technique's nuances are essential for mastering this critical skill.

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