Direct puncture capsulorhexis

I describe a simple technique for performing capsulorhexis without viscoelastic material or expensive instruments. A slightly barbed, bent, 30-gauge needle is used to directly puncture clear cornea and create a capsulorhexis without the need for a groove or stab incision. Hydrodissection is carried out with the attached 1 cc syringe (tuberculin) filled with a balanced salt solution. Hydrodissection, hydrodelineation, and mobilization of the nucleus can be carried out before the eye is entered with a blade. With direct puncture, the technique is immune to the effects of high intraocular pressure and a shallow anterior chamber. The Technique is ideally suited for bimanual microincision phacoemulsification.