Doughnut capsulorhexis: Pioneering advancements in cataract surgery to sidestep Argentinian flag sign

Background: For a successful capsulorhexis, it is crucial to use controlled centripetal and tangential vector forces in the rhexis border to counteract the centrifugal forces of the zonular component. Unfortunately, in hypermature cataracts, these maneuvers do not prove successful due to the raised intralenticular pressure, leading to an Argentinian flag sign. Among several techniques, this method of doughnut capsulorhexis is one such technique to perform successful capsulorhexis in cases with high intralenticular pressure. Purpose: In this video, we highlight this new method of capsulorhexis to prevent undue capsule-related complications in hypermature cataracts, as this plays a crucial role in successful surgical outcomes. Synopsis: The lens capsule usually experiences centrifugal vector forces exerted by the zonules, but in hypermature cataract cases, there is an additional factor of raised intralenticular pressure. In such cases, the attempts to make a 5 mm capsulorhexis might lead to the propagation of the rhexis to the periphery due to the combined mechanism of the two vector forces. Therefore, the technique of performing a smaller 2 to 3 mm rhexis is performed. This reduces the centrifugal force involved and prevents undue extension of the rhexis. Following this, decompression of the capsular bag is performed by aspirating the liquefied cortex using a bimanual irrigation and aspiration cannula, followed by controlled extension of the rhexis using a cystitome, which is performed for a successful surgical outcome. The second knick is made parallel to the first rhexis,1 mm away from the rhexis border, and a flap is raised. The rhexis can either be completed using a cystitome or a microrhexis forceps. Highlights: This technique does not require any additional instrumentation or training. It can be performed using the cystitome and microrhexis forceps. Surgeons of all calibers can efficiently perform it. This series of videos shows the successful outcome of continuous curvilinear capsulorhexis using the Doughnut method. Video Link: https://youtu.be/x0dTklOaMqg