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ABSTRACT
A simple modification of the bent needle cystltome allows a more precise and regular anterior capsulotomy in extracapsular cataract surgery.
The performance of the anterior capsulotomy is one of the most important stages of the extracapsular cataract extraction. The surgeon desires to make a precise capsulotomy with regular edges, avoiding stress to the capsular-zonular diaphragm. Several methods to accomplish this have been advocated: mechanical, automated, or photodisruptive.
Presently, most surgeons employ a mechanical technique. Instruments used include scissors, cystitomes, or bent needles.1 I suggest a modification of the standard use of the bent needle technique.
SURGICAL TECHNIQUE
When a bent needle is used for anterior capsulotomy, it is usually prepared by bending the distal tip of the needle 90 degrees away from its lumen. This produces an instrument which has two sharp cutting edges at right angles to its shaft. Thus, it cuts precisely through the capsule with tiny side-to-side movements, but only in a direction at right angles to its shaft, i.e., from 4 o'clock to 8 o'clock in the inferior third of the capsule (Figure 1). As the needle is used to cut the capsule at its lateral edges (from 12 o'clock to 4 o'clock and from 8 o'clock to 12 o'clock), the movement of the needle cannot be used in a side-to-side direction, and must be used to tear or stab rather than cut the capsule. This is a much less...