Scleral Ledge in Cataract Incision: a Cause of Rupture of the Capsule.

Most surgeons seem to favour the former method. Even when the erisophake is used instead of forceps, the technique of zonulolotomy and delivery of the lens remains essentially the same. Since the introduction of A.C.T., however, mechanical zonulolotomy has been replaced by enzymatic zonulolysis and the extraction of the lens by seizing it at the 12 o'clock position is being increasingly practised. Rupture of the capsule used to be attributed to the toughness of the zonule, but it is now observed that even enzymatic zonulolysis has failed to eliminate this complication, which has been reported by various authors using both forceps and the erisophake. The obstruction caused by the scleral ledge formed by the posterior lip of the incision to the equator of the lens appears to be responsible for most ruptured capsules after the use of A.C.T., but to the best of my knowledge, neither the scleral ledge nor its role in causing rupture of the capsule has been specifically mentioned in the literature before.