apsulorrhexis has been the most favored form of capsulotomy over the past two decades.¹ Capsulorrhexis produces the strongest capsulotomy rim of any capsulotomy to date because it produces a continuous tear within normal tissue planes. But capsulorrhexis is not without its limitations.

First, the surgeon attempts to tear a round opening in a convex surface. The force vector on the surface of a convex structure is toward the peripheral equator of the lens; the surgeon counters this by pulling the tear toward the center of the lens. If the tear slips into the periphery, then we have a surgical crisis. Two of the issues that cause problems with capsulorrhexis include poor visibility and raised intracapsular pressure. The total force or pressure that the nucleus and cortex place on the internal surface of the lens capsule is directly related to the surface area of the anterior capsule. Because the area of the lens capsule is πr², the diameter of the capsulotomy has a high impact on the total force placed against the rim of the lens capsulotomy. Recall that the total force placed on the internal surface of the anterior capsule is related to the square of the radius of the capsulotomy. For this reason, 7-mm capsulotomy results in an immense decrease in the total force on the internal surface of the anterior capsule rim as compared with 5-mm capsulotomy. Therefore, the risk of a tear of the anterior capsule rim in 7-mm capsulotomy is much lower than that in 5-mm capsulotomy. A 7-mm Fugo blade capsulotomy is easy and safe, whereas 7-mm capsulorrhexis carries a high risk of a tear into the periphery. Poor visibility is a minimal risk with a Fugo blade capsulotomy because it is quite easy to perform Fugo blade capsulotomy under the iris out of direct visualization of the surgeon.² This also allows maximum control over corneal pathology, such as Saltzman nodular degeneration. Complicated surgeries such as floppy iris syndrome are much more controlled and made safer using Fugo plasma ablation rather than capsulorrhexis, because Fugo blade capsulotomy can be created under the uncooperative iris out of view of the surgeon.^3,4 Furthermore, standard capsulorrhexis creates postoperative complications such as capsule retention syndrome and capsular phimosis.⁵ These pathologies are all but eliminated with a large Fugo blade capsulotomy. Fugo blade capsulotomy offers significant advantages over standard capsulorrhexis. Unlike standard diathermy, a Fugo blade capsulotomy provides rim strength that is close to that of standard capsulorrhexis.^6,7 Ophthalmologists finally have an alternative to performing capsulorrhexis.

References

1. Gimbel HV, Neuhann T. Continuous curvilinear capsulorrhexis. J Cataract Refract Surg. 1991;17:110–111.

2. Fugo RJ, DelCampo DM. The Fugo blade™: the next step after capsulorrhexis. Ann Ophthalmol. 2001;33:12–20.

3. Ronge L. How to use the Fugo blade. EyeNet. 2003; 7:23–24.

4. Young M. Fugo blade finds its niche in difficult cases. Eyeworld. 2003;8:70.

5. Sabbagh LB. Rhexis can hold IOL when posterior capsule breaks. Ocular Surgery News. 1992;3:1–10.

6. Wilson ME, Trivedi RH. Technological advances make pediatric cataract surgery safer and faster. Tech Ophthalmol. 2003;1:53–61.

7. Wilson ME. Anterior lens capsule management in pediatric cataract surgery. Trans Am Ophthalmol Soc. 2004;102:391–422.

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