Simulated Surgery: Phacoemulsification: Creating Incision and Performing a Capsulorhexis

The SOS Basic Gel Cataract eye is being used here to demonstrate how to practice making a self-sealing corneal incision, fill the anterior chamber with viscoelastic and then perform a continuous curvilinear capsulorhexis, using forceps. The life-like capsule material has tearing vectors which are similar to the ones in the human eye.

In addition to Cybersight, you can find videos featuring teaching techniques for all types of ocular surgery, using any form of simulation, in the Simulation Gallery.


>> In this video, we’re using an SOS basic phaco eye to practice creating a corneal incision and our capsulorrhexis technique. Here we’re using a three-step corneal incision. Just dipping the blade down towards the lens. That’s the last bit of that maneuver, and here a single paracentesis, using the same blade. I’m placing a little mark here, just on the sclera, so it’s easier to find the side port. And a second side port entry here. On the nasal side. Just going to fill the eye up with viscoelastic. And what we tend to do is just ask the theater team to keep the viscoelastic from theater that morning. There’s usually half a syringe left in most cases. And to use this for our simulation. So having achieved a good fill, we’re going in with the capsulorrhexis forceps. And my preferred technique is to initiate a tear with the capsulorrhexis forceps, dragging down centrally towards the incision, picking up the edge of the flap, and then starting to tear the capsule round in a counterclockwise direction. Our trainees will have completed their IC training modules, and many of them will have performed multiple capsulorrhexes on the IC. So this is an opportunity for them to put into practice the techniques that they have learned, using the IC. And again, you can use a cystotome, just as easily as you can use the capsulorrhexis forceps. And the same principles apply to the IC training, which is just leading that capsule round, folding the capsule remnants over on themselves, so they don’t get in your way, and completing a nice circular rhexis. And finally, just removing the capsule remnants. This is also a basic cataract eye, but has a hard nucleus, as opposed to the softer gel nucleus. And just as in real life, sometimes the capsule with the harder nuclei is a little bit more adherent to the underlying lens. It can be a little bit difficult just to get that tear going. Just opening up the initial groove there. Unlike the advanced phaco eyes, which for posterior chamber we cannot bury the pressure behind the lens here, because they’re hemispherical eyes, and so you cannot simulate the capsulorrhexis tearing out due to raised intravitreal pressure, but nevertheless, if the trainee takes the capsule too close towards the iris, it will still tear out. And again, it just helps consolidate what they’ve learned on the IC, before progressing to live surgery. Finally, just leading the rhexis round to complete 360-degree tear.

Last Updated: October 31, 2022

2 thoughts on “Simulated Surgery: Phacoemulsification: Creating Incision and Performing a Capsulorhexis”

Leave a Comment