Circular Capsulorhexis Research Articles

Irrigating Capsule Retractor for Posterior Nucleus Hydrodissection

An irrigating capsule retractor for safe nucleus delivery in planned extracapsular cataract extraction (ECCE), particularly after circular capsulorhexis and curvilinear capsulotomy using an envelope technique, is introduced. This retractor, which consists of a 20-gauge needle with a flattened top, provided with a fine-wire hook, can be used to bring the upper nucleus equator out of the capsular bag as well as to perform posterior nucleus hydrodissection. The cannula is especially helpful in performing circular capsulorhexis in a small diameter.

Endocapsular Cataract Surgery Following Small Circular Capsulorhexis

Endocapsular cataract surgery was performed including posterior chamber lens implantation through a capsular opening of 3–4 mm created by small circular capsulorhexis in 18 eyes. The measured diameter of the capsular opening postoperatively ranged from 3.07–4.18 mm with a mean of 3.75 ± 0.29 mm. The anterior capsular margin withstood the tension which was exerted when a 6 mm PCL optic was passed through, except in one case, and during the entire procedure in every case without tearing. The result is better IOL fixation with a large capsular opening, since capsular integrity is better preserved.

Posterior Capsule Tears Using Phaco-emulsification Causes, Prevention and Management

A 2-year study of posterior capsule tears during cataract extraction and lens implantation was carried out at the Gimbel Eye Centre. 7174 consecutive cases of cataract extraction were analyzed in a prospective study. 7159 cases or 99.8% were accomplished using phaco-emulsification. Eight or 0.1% were by extracapsular extraction (ECCE), 2 of which were planned and 6 which were converted from phaco-emulsification because the nucleus was too dense. Seven or 0.1% were by intracapsular extraction (ICCE), 3 of which were planned and 4 which were converted from phaco-emulsification, all because the zonular fibres were too loose to support the capsule. Of the 7169 cases attempted by phaco-emulsification, an intraoperative posterior capsule (PC) tear occurred in 36 cases or an incidence of 0.5%. Of these 36 cases, 35 involved planned intraocular lens implantation, all of which were achieved. The causes of PC tears, their management, and outcomes were examined. The contribution of anterior Continuous Circular Capsulorhexis (CCC) in the prevention of posterior capsule tears is discussed and the application of this same principle to posterior continuous circular capsulorhexis (PCCC) as developed by the author for management of some posterior capsule tears is presented.

Double Circular Capsulotomy and Intercapsular Phaco-emulsification

We performed a new surgical technique termed double circular capsulotomy and intercapsular phaco-emulsification, in which both the advantages of a circular capsulotomy and intercapsular surgery are utilized. This technique consists of three stttteps: (1) small circular capsulotomy is performed with a diameter of about 3 mm; (2) intercapsular phaco-emulsification is performed between the capsules with the tip inserted through the small capsulotomy opening; (3) a large circular capsulorhexis is performed before lens implantation. As a result, complete in-the-bag fixation can be obtained as capsular integrity is maintained. The mean rate of endothelial cell loss is only 3.9% including hard cases. This double circular capsulotomy and intercapsular phaco-emulsification technique is a very promising method for advancing small incision surgery.

Development, advantages, and methods of the continuous circular capsulorhexis technique

The development of the continuous circular capsulorhexis (CCC) technique has contributed significantly to the safety and effectiveness of cataract extraction and intraocular lens implantation. This technique facilitates every, size of smooth, circular, capsular opening, and it produces a strong capsular rim that resists tearing even when stretched during lens material removal or lens implantation. Maintaining the general integrity of the eye and facilitating such procedures as hydrodissection, endolenticular phacoemulsification, capsule polishing, and safe lens implantation in both adults and children are some of the advantages of CCC. This procedure can be performed in several ways, and it has been proven to be consistently reproducible by experienced surgeons.

Systematic surgical procedures to secure more stable in-the-bag intraocular lens fixation

Several conditions have to be fulfilled to retain the integrity of the capsular bag for a long period after intraocular lens fixation: (1) The anterior capsular window should be small (5 mm) and round, with no radial tears; (2) the equator of the capsular bag should be almost circular; (3) the retained capsular wall should be transparent and (4) it should have no deformity. To meet these conditions, systematization of several innovative procedures is required. The system that we propose comprises continuous circular capsulorhexis (Neuhann and Gimbel), hydrodelamination (Brint), roundel phacoemulsification (Hara and Hara), new IOL designs, and intraoperative extensive lens epithelial cell removal. A description of each procedure is presented.

Double-hook extraction technique

To prevent the occurrence of a radial tear at the edge of the continuous circular capsulorhexis at nucleus extraction, I have been performing a new nucleus extraction technique called double-hook extraction. This technique consists of three steps: Step 1, fluid dissection; Step 2, double-hook extraction; Step 3, extraction of the nucleus from the eye. This technique is an easy, safe, and effective way to maintain capsular integrity and implant posterior chamber lenses completely in the bag after planned extracapsular cataract extraction.

Further development of experimental techniques for refilling the lens of animal eyes with a balloon

Various techniques for experimental refilling of the lens of animal eyes are possible. We describe two new methods: Balloon insertion after endocapsular phacoemulsification and after phacoemulsification with circular capsulorhexis. The feasibility of these techniques was tested in both rabbit eyes and pig cadaver eyes. With organosilicone gel as the balloon filling material, postoperative refractive changes of up to 4 diopters of residual hyperopia were achieved; accommodation changes were up to −1 diopter. The technique of refilling the lens with a balloon to avoid leakage of filling material warrants further study.