A NOVEL POSTERIOR CAPSULORHEXIS TECHNIQUE FOR CATARACT SURGERY USING COHESIVE VISCOELASTIC STABILIZATION

Abstract

Posterior capsule opacification remains the most common long-term complication following cataract surgery and may lead to decreased visual acuity requiring Nd:YAG laser capsulotomy. Although several surgical approaches have been proposed to maintain a clear visual axis, many techniques involve additional surgical steps, specialized equipment, or manipulation of the posterior capsule after intraocular lens implantation.

A novel posterior capsulorhexis technique based on stabilization of the capsular planes using cohesive viscoelastic is presented. After completion of phacoemulsification and removal of cortical material, cohesive viscoelastic (sodium hyaluronate 1.6–1.8%) is simultaneously injected into the anterior and posterior chambers to align the anterior and posterior capsules within the same plane and induce posterior rotation of the lens–iris diaphragm. A central puncture is created in the posterior capsule, followed by formation of a continuous circular posterior capsulorhexis using capsulorhexis forceps. During the circular maneuver, the capsule is regrasped as needed to maintain controlled traction and minimize stress on the anterior hyaloid membrane. In cases of mild vitreous protrusion, additional cohesive viscoelastic is injected into the capsular bag to reposition the hyaloid fibers posteriorly. The intraocular lens is subsequently implanted intracapsularly within the capsular bag. The posterior capsulorhexis is created approximately 1.5–2.0 mm smaller than the anterior capsulorhexis.

The described technique allows controlled formation of posterior capsulorhexis while maintaining capsular stability and intracapsular intraocular lens implantation. By stabilizing the capsular planes with cohesive viscoelastic, the method facilitates safe manipulation of the posterior capsule and controlled separation from the anterior hyaloid membrane. This approach represents a simple and cost-effective modification of cataract surgery that can be integrated into routine phacoemulsification procedures.