Modified capsulorhexis for fluid-filled mature cataracts

Abstract Background: The aim of this study was to develop a modified capsulorhexis technique featuring a new maneuver for the removal of subcortical fluid in fluid-filled mature cataracts to avoid high intralenticular pressure. Methods: This prospective interventional study included ۳۳ eyes with mature cataracts and evidence of subcapsular fluid spaces by slit lamp examination. For each patient, ۲۰% mannitol was administered intravenously according to the bodyweight ۱ h preoperatively. Under peribulbar anesthesia, a ۲.۲-mm main incision was made, and the anterior chamber was filled with a dispersive ophthalmic viscosurgical device. Using a bent-tip cystotome, a ۲-mm curved incision was made in the center of the anterior capsule, which released subcortical fluid and was drained through compression of the posterior lip of the main incision using a spatula. Then, fine gentle milking in all quadrants around the puncture on the anterior lens capsule from the periphery toward the site of puncture using the blunt-edged spatula further assists drainage of subcortical fluid and breaks fine septa inside the lens to remove fluid from intralenticular fluid pocket collections. Results: The study included ۱۵ (۴۵.۵%) men and ۱۸ (۵۴.۵%) women with a mean ± standard deviation (SD) of age of ۶۳.۲ ± ۵.۳۳ and ۶۴.۴ ± ۶.۲۱ years, respectively. The modified capsulorhexis technique was performed for ۳۳ intumescent cataracts. Capsulorhexis was completed in all cases; capsulorhexis was easy in ۳۱ (۹۴%) eyes and difficult in ۲ (۶%) eyes. In the two difficult cases, radial extension occurred in one eye, and it was retrieved using the Little technique; the other case with radial tear was completed successfully using a retinal micro scissor from the other edge of the capsulorhexis until reaching an oval, continuous capsulorhexis. Conclusions: This modified capsulorhexis technique with compression on the posterior lip of the main incision and capsule milking allowed for a safe, continuous curvilinear capsulorhexis. Further comparative studies are necessary to confirm our preliminary results.