Direct puncture capsulorhexis

Abstract

I describe a simple technique for performing capsulorhexis without viscoelastic material or expensive instruments. A slightly barbed, bent, 30-gauge needle is used to directly puncture clear cornea and create a capsulorhexis without the need for a groove or stab incision. Hydrodissection is carried out with the attached 1 cc syringe (tuberculin) filled with a balanced salt solution. Hydrodissection, hydrodelineation, and mobilization of the nucleus can be carried out before the eye is entered with a blade. With direct puncture, the technique is immune to the effects of high intraocular pressure and a shallow anterior chamber. The Technique is ideally suited for bimanual microincision phacoemulsification.

Capsulorhexis rescue after peripheral radial tear-out: Quick-pull technique

“…5 Surgical techniques to avoid tear-out include direct puncture capsulorhexis, 11 2-stage capsulorhexis, 2 and diathermy probe. 12 There are also techniques for capsulorhexis rescue after the identification of tear-out; ie, reversing the force vector on the capsule flap, 6 using a 22-gauge needle or microforceps in a counterclockwise direction, 7 and using trypan blue to "find" the leading edge of a "lost" lens.…”