In the rare event of a micro-adhesion you must complete the circular capsulorrhexis without having the anterior capsule tear.
Very very occasionally there will be capsular micro-adhesions where the capsule has not been cut completely free. There are various types of tags.
- One or two small micro-adhesions in an otherwise free flap
- A localised area with multiple small tags which may be due to a corneal opacity blocking the laser from reaching the capsule.
Grab the free end of the capsulorrhexis flap and gently guide the leading edge so that the capsulorhexis is completed. This can be done by lifting the flap and pulling centrally, which will generate a circumferential vector.
Alternatively you can continue separating the capsulorrhexis in the opposite direction until you return to the area of the tag. This usually will allow the two ends to join.
If the imperforate area is larger, you can also fold the capsule and complete the capsulorrhexis in a shearing manner. This sometimes creates a new line of cleavage either inside or outside the laser induced capsulorrhexis, but this does not seem to cause any problems if it joins the original capsulorrhexis again. It is preferable if the new line of cleavage is outside the original incision rather than inside it.
Avoid any rapid intraocular movements and let your fingers “muscle memory” guide you into completing the capsulorrhexis, just as you would have done if you never had a femtosecond laser.
Next step: Hydrodisection