Surgeons who encounter this situation should abandon their standard capsulorhexis technique and create the anterior capsule opening, instead using an instrument for cutting through the toughened tissue, said Michael A. Mahr, MD.
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“Surgeons should not hesitate to cut the capsule due to concern about causing a radial tear because the good news is: a capsule that won’t intentionally tear because it is fibrotic is also less likely to unintentionally tear,” said Dr. Mahr, assistant professor of ophthalmology, Mayo Clinic, Rochester, MN. “On the other hand, surgeons should recognize that continued effort to tear the capsule is risky as the stress can lead to zonular damage or some other problem.”

Dr. Mahr spoke from personal experience with a patient who was referred for surgery for a white cataract. The patient had undergone vitreoretinal surgery eight years earlier for a giant retinal tear with pars plana vitrectomy, endolaser, scleral buckle, and placement of silicone oil that was never removed.