Management of Radial Tears During Capsulorhexis

Radial tears during continuous curvilinear capsulorrhexis (CCC) are one of the most unwanted events that a surgeon may experience during cataract surgery. There are many factors that may play a role in inducing radial tears during CCC, such as a shallow anterior chamber, weak zonules as seen in pseudoexfoliative syndrome (PEX), high positive vitreous pressure, intumescent and hypermature cataracts, pediatric cataracts and a surgeon with minimal experience performing CCC. I describe a technique in which by aspirating the anterior epinuclear lens materials prior to phacoemulsification (PE), we can produce some free space between the nucleus and lens capsule and then can rotate the nucleus without complete hydrodissection and safely proceed with PE after cortex aspiration by engaging the nucleus between the phaco tip and a second instrument with the help of high vacuum and by cracking the nucleus without sculpting or chopping in order to minimize the stress on the zonules and prevent extension of radial tears during CCC.