Instrument to Manage Radial Tear in Continuous Curvilinear Capsulorrhexis (CCC)

Abstract

 Purpose: To evaluate the surgical outcome difficulties and complications of managing radial tear in continuous curvilinear capsulorrhexis by using lunar punch.

Material and Methods: A prospective case series of sixteen patients who developed tear in the continuous curvilinear capsulorrhexis during cataract surgery at eye unit-III of Sindh Govt. Lyari General Hospital and Dow University of Health Sciences Karachi from July 2008 to June 2009. Upon recognition of a radial extension of the anterior capsule. Lunar Punch was introduced beneath the radial tear by rubbing over the lens cortex and punched to convert it into a lunar edge. After this maneuver capsulorrhexis was completed in a usual manner. After securing the capsulorrhexis the procedure of phacoemulsification was performed in the usual manner.

Results: There were ten (62.5%) males and six (37.2) females with a mean age of 45.5 years. Predisposing factors for extension of capsulorrhexis were shallow anterior chamber in 1(6.3%) cases, inexperienced surgeon in 6(37.6%) cases, inadequate local anesthesia in 1(6.3%) cases, intumescent cataract in 1.(63%) cases, positive vitreous pressure in 3(18.8%) cases, hypermature cataract in 2(12.2%) cases and weak zonules in 2(12.2%) cases. Some complications resulted during and after the procedure were postoperative striate keratopathy in 3 (18.8%) cases, vitreous loss in one (6.3%) case and lens dislocation in one (6.3%) case. Eleven (68.8%) cases had no complication. We achieved success in fourteen (87.5%) cases.

Conclusion: Managing radial tear in CCC by using lunar punch is a safe and effective procedure, which can be adopted easily and effectively