A Modified Needle Technique for Enlarging a Small Capsulorhexis Under the Main Incision

To describe and evaluate a modified technique for safely enlarging a small continuous curvilinear capsulorhexis (CCC) during cataract surgery, particularly when the margin of the small CCC lies beneath the main incision, where conventional capsule scissors are difficult or impossible to use.

We describe a bimanual technique in which a manually bent 27-gauge needle is used to create a controlled capsular flap while the capsulorhexis forceps simultaneously stabilize the anterior capsule, facilitating safe and controlled enlargement of a small primary CCC. The technique can be performed at various surgical stages after sufficient viscoelastic has been injected to flatten the anterior capsule. This procedure was applied in eyes requiring CCC enlargement. Clinical outcomes, including capsulorhexis diameters before and after enlargement (measured using image analysis software) and the occurrence of using complications (eg radial tears, zonular damage), were retrospectively analyzed.

Between April and November 2025, a total of 1860 cataract surgeries were performed, of which 39 eyes (2.09%) required CCC enlargement. In 20 of these cases, the modified needle technique was employed, primarily for CCCs under the main incision. Enlargement was successful in all 20 cases, with the mean CCC diameter increasing from 4.34 ± 0.44 mm preoperatively to 5.07 ± 0.28 mm post-enlargement. No intraoperative complications such as radial capsular extension or zonular dialysis occurred. During follow-up, no late complications, such as capsular phimosis or intraocular lens decentration, were observed.

The described 27‑gauge needle technique appears to be a feasible, safe, and accessible method for enlarging a small CCC in selected cases. It is particularly useful for managing small capsulorhexes situated under the main incision, where conventional instruments have limited access.