"Inverted flap rhexis" - Salvation of intumescence

Intumescent cataract can be a challenge even for an experienced surgeon, particularly for creating a continuous curvilinear capsulorhexis (CCC) because of increased endolenticular pressure. CCC in white intumescent cataract is associated with increased risk of extension of rhexis margin leading to radial tear or biradial extension causing "Argentinian flag sign" and associated complications. We describe a novel technique for CCC, in which we manipulate the vector forces acting in creating a capsulorhexis. After making a mini CCC, a flap is raised and then inverted under the rhexis margin and CCC is done by keeping the flap inverted using shearing and tearing forces, keeping the direction of force down and toward the center in a curvilinear fashion. It is a new surgical technique to perform a successful and safer CCC in intumescent cataract with consistent outcome.