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EW NEWS & OPINION 19 pling of the capsule. As the needle tips approach and ultimately pass each other, either one or the other needle must penetrate into the lens, with the opposing tip acting as countertraction (Figure 2). Once the capsule has been suc- cessfully violated, the edge can be grasped by a microforceps and peeled into a capsulorhexis. Direct- ing the tear initially away from the strongest zonules (if there are any) will allow this countertraction to get things started (Figure 3). If in one meridian or another the shear force resistance to the tear is inadequately opposed by the combined forces of the remaining zonules and the inter- nal forces of the lens material on the equator, the capsule can be sup- ported by a flexible retractor placed around the partial capsulorhexis margin, serially placed as the tear is continued. Other larger capsule sta- bilizing devices that extend around to the equator may be more chal- lenging to insert. Notwithstanding, with profound looseness, an Ahmed segment can be placed after the first half of the capsulorhexis to create some countertraction for CCC com- pletion. Alternatively, a smooth mi- croforceps can be used to grasp the capsule to stabilize the lens with the non-dominant hand during this process. Frequently, the area of greatest zonulopathy does not con- veniently correspond to the merid- ian of the primary wound. The use of either reusable or disposable 23- or 25-gauge microforceps can access the capsule from different directions via multiple paracenteses (Figure 3). Other points to note The centration of the CCC should be on the center of the lens. One should be cautious of making the tear too peripheral, in which case the tear may extend into the healthy zonules in the better attached area and thus extend the tear peripher- ally. If too peripheral in the area of greatest looseness, an inadequate capsular lip will not hold a capsular tension ring or segment in the bag fornix under any tension. A tremendous sense of both sat- isfaction and relief typically coin- cides with the successful completion of the capsulorhexis. EW Editors' note: Dr. Snyder has no finan- cial interests related to his comments. Contact information Synder: 513-984-5133, msnyder@cincinnatieye.com September 2011 Do not miss this opportunity! - Brazil Executive Secretary Dr. Leonardo Akaishi Implants (SBCII) 2010 to 2012 President of the Brazilian Society of Cataract and Intraocular Dr. Howard Fine Coordinator of International Speakers Dr. Newton Leitão de Andrade Surgery (SBCR) 2010 to 2012 President of the Brazilian Society of Refractive phone: 55(17) 3214-5900 / fax: 55(17) 3214-5905 e-mail: c cenacon@cenacon.com.br VIII International Congress of Administration in Ophthalmology International Congress of the Brazilian Society of Ocular Plastic Surgery International Congress of the Brazilian Society of Ophthalmology Nursing

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