A capsule rhexis in fibrotic capsule

Capsulorhexis is a challenging task when you are dealing with thick fibrotic capsule as in advanced cataracts. In this video we have shown series of complicated cataract with anterior capsular fibrosis. We shown various techniques to tackle such difficult situations using various tools One technique may work in a case whereas different technique may have to be used for te other case. Combination of various techniques is required in few cases.
In the first case, a cystitome is used to initiate the nick in the anterior capsule .A spatula is used to separate the anterior capsule along with subcapsular plaque and is cut with scissors. Further capsulotomy is completed with vitrectomy cutter. Initially low cut rate with high vaccum is used to initiate the cut and later slightly higher cut rate is used to get a smooth capsulotomy margins.
In the second case, a straight 26 G needle loaded on a 2cc syringe is used to aspirate intumuscent white cataract to reduce intralenticular pressure. Rhexis is done with foreceps and aided by micro scissors to cut the fibrotic adhesions of the capsule.
In the third case, rhexis foreceps, scissors and vitrectomy cutter is used to complete the rhexis