• Users Online: 440
  • Home
  • Print this page
  • Email this page

   Table of Contents      
Year : 2005  |  Volume : 53  |  Issue : 3  |  Page : 214-215

A simple technique for nucleus extraction from the capsular bag in manual small incision cataract surgery

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China

Correspondence Address:
Srinivas K Rao
Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, 3/F, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong SAR
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0301-4738.16693

Rights and Permissions

How to cite this article:
Rao SK, Lam DS. A simple technique for nucleus extraction from the capsular bag in manual small incision cataract surgery. Indian J Ophthalmol 2005;53:214-5

How to cite this URL:
Rao SK, Lam DS. A simple technique for nucleus extraction from the capsular bag in manual small incision cataract surgery. Indian J Ophthalmol [serial online] 2005 [cited 2022 Aug 13];53:214-5. Available from: https://www.ijo.in/text.asp?2005/53/3/214/16693

Dear Editor,

Preserving the architecture of the capsular bag permits IOL implantation within the capsular bag, and increases the safety and efficacy of extracapsular cataract surgery. This paper describes a safe, repeatable way of extracting the nucleus from the capsular bag. Two paracenteses are created at 900sub to the main wound and a rhexis decentered towards the main incision is performed. After thorough hydrodissection is performed to ensure that the nucleus is freed from its capsular attachments and rotates freely within the capsular bag, two Sinskey hooks are introduced through the paracenteses, and the one held in the left hand is slipped under the rhexis with the tip held horizontally and pointing towards the wound [Figure - 1]a. The tip is advanced until the pole of the lens is reached, extrapolating the position of the tip using the distance from the pupillary margin as a guide, and it is then turned posteriorly to engage the substance of the nucleus at the equator of the lens [Figure - 1]b. Continued rotation moves the superior pole of the nucleus towards the margin of the rhexis and the surgeon then lifts the hook anteriorly to bring the superior pole of the nucleus into the anterior chamber [Figure - 1]c. The second hook held in the right hand is placed underneath the elevated superior pole of the nucleus to keep it above the margin of the capsulorhexis, and to prevent it from falling back into the bag when the first hook is retracted. The first hook is then disengaged from the nucleus and used to dial the nucleus out of the capsular bag [Figure - 1]d.

The viscoelastic in the anterior chamber provides protection for the endothelium, even when this maneuver is performed with dense nuclei, with insignificant changes in the postoperative endothelial counts (unpublished data). Ideally, a rhexis size of 6 to 6.5 mm would be required for very dense nuclei, while a rhexis of 5 to 5.5 mm should suffice for less dense nuclei. However, an equivalent nucleus can be extracted through a smaller opening with this technique, than would be possible with the hydrostatic expression[1] or tumbling techniques.[2] This approach can be used with a small pupil, when the rhexis margin is spilt in one or more places, and in eyes with compromised zonular status. We have performed nearly fifty procedures using this technique, including the difficult situations described, with no complications.

  References Top

Thim K, Krag S, Corydon L. Hydroexpression and viscoexpression of the nucleus through a continuous circular capsulorhexis. J Cataract Refract Surg 1993;19:209-12.  Back to cited text no. 1
Maloney WF, Dillman DM, Nichamin LD. Supracapsular phacoemulsification: a capsule-free posterior approach. J Cataract Refract Surg 1997; 23:323-8.  Back to cited text no. 2


  [Figure - 1]

This article has been cited by
1 Global preferred practice patterns in manual small incision cataract surgery
Charmi Hareshkumar Madhani, Kinjal Yogeshbhai Trivedi, Purvi Raj Bhagat
Global Journal of Cataract Surgery and Research in Ophthalmology. 2022; 1: 4
[Pubmed] | [DOI]
2 Small incision cataract surgery with trabeculectomy versus phacoemulsification trabeculectomy in pseudoexfoliation glaucoma
S Ramyashri, Aparna Rao, Debanand Padhy, Gopinath Das
Indian Journal of Ophthalmology. 2020; 68(6): 1090
[Pubmed] | [DOI]
3 Review of manual small-incision cataract surgery
Kamaljeet Singh, Arshi Misbah, Pranav Saluja, ArunKumar Singh
Indian Journal of Ophthalmology. 2017; 65(12): 1281
[Pubmed] | [DOI]
4 Manual Small Incision Cataract Surgery
Rengaraj Venkatesh,David F. Chang,Radhakrishnan Muralikrishnan,Kenia Hemal,Pariskshit Gogate,Sabyasachi Sengupta
Asia-Pacific Journal of Ophthalmology. 2012; 1(2): 113
[Pubmed] | [DOI]
5 Project vision: a new and sustainable model for eliminating cataract blindness in China
Clinical & Experimental Ophthalmology. 2009; 37(5): 427
[Pubmed] | [DOI]
6 Project vision: A new and sustainable model for eliminating cataract blindness in China
Lam, D.S., Li, E.Y., Chang, D.F., Zhang, M.-Z., Zhan, H.-K., Pang, C.-P.
Clinical and Experimental Ophthalmology. 2009; 37(5): 427-430
7 Small incision cataract surgery: Complications and mini-review
Gogate, P.M
Indian Journal of Ophthalmology. 2009; 57(1): 45-49
8 Endothelial cell loss and surgically induced astigmatism after sutureless large-incision manual cataract extraction (SLIMCE)
Lam, D.S.C., Rao, S.K., Fan, A.H., Congdon, N.G., Wong, V., Liu, Y., Lam, P.T.H.
Archives of Ophthalmology. 2009; 127(10): 1284-1289


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
Article Figures

 Article Access Statistics
    PDF Downloaded297    
    Comments [Add]    
    Cited by others 8    

Recommend this journal