Enlargement of a Preexisting Capsulorhexis

The article describing a technique of enlarging a preexisting capsulorhexis1 does not clearly justify theuse of Sinskey hooks, which have blunt tips, to initiate a small tear in the anterior capsule. To try to pull on an unsupported anterior capsule with these hooks, without an underlying intraocular lens (IOL) or lens, will lead to an inadvertent pull on the capsule zonules, which may lead to zonular dialysis. The authors stress that using Sinskey hooks does not disturb the wound architecture, but we do not understand this since the capsulorhexis has to be enlarged using a much larger capsulorhexis forceps through the wound and then implanting an IOL. To enlarge a capsulorhexis with 2 blunt Sinskey hooks on an unsupported anterior capsule appears to be risky even in the best of hands. In cases in which the capsulorhexis appears small, we find it is safe and much easier to start a second capsulorhexis by making a small nick with a cystotome. The capsulorhexis can then be enlarged using a forceps or bent cystotome under viscoelastic pressure. This can be done before starting to emulsify the lens or after implanting an IOL. Mr Nachiketa MD, FRCSed Vineeta Munshi MD, FRCSed Birmingham, UK, England