Prerequisites

• Absence of positive pressure
  • Visco-elastics
  • Closed chamber technique
• Instruments
  • Cystitome
  • 26G bent needle
  • Capsule forceps
    

Procedure

• Either clock wise or counter clockwise
• Only light touch is needed
• Last part of the tear should join the first part from periphery towards the center
• Otherwise tear extends to the equator
• Initiation of the tear:
  

• The cut is extended vertically  and then horizontally to the right to create a flap:

• The flap is pulled around in a circular manner by the needle tip with gentle traction:

Mechanics of Rhexis

• Rhexis by forceps
  • Tear  extends by ripping
  • The flap is elevated off the capsule
• Rhexis by needle
  • Tear extends by shearing
  • Capsule gets folded posteriorly at the tearing vertex

Advantages of CCC

• Facilitates "in the bag IOL"
• Easy and safe aspiration of peripheral cortex
• In case of posterior capsule rent- IOL can be implanted over the rhexis margin
• Less stress on zonules
• Chances for posterior synechiae formation is less
• PHACO can be carried out in the bag

Rhexis in Intumescent Cataract

• Rhexis is difficult in intumescent cataract
• Absence of red glow
• Peripheral extension of tear
• Leaking out milky cortex
• Initial decompression of lens by aspirating the cortex
• Perform rhexis under air

Click here for a video of capsulorhexis in intumescent cataract

Linear Capsulotomy