Biomechanical control of continuous curvilinear capsulorhexis: a structured video-based analysis of error patterns and recovery maneuvers.

PURPOSE: Continuous curvilinear capsulorhexis (CCC) remains a critical step in cataract surgery and a frequent source of difficulty during surgical training. This study analyzes recurrent biomechanical error patterns and standardized recovery maneuvers during capsulorhexis using a structured video-based approach.

METHODS

This retrospective, observational study evaluates a consecutive series of 50 cataract surgeries performed by a single surgeon during an intensive training program. Intraoperative videos were reviewed with attention to flap handling, traction-vector alignment, pivoting, and anterior chamber stability.

RESULTS

Capsulorhexis deviation or loss of controlled tear propagation was identified in 23 of the 50 procedures (46%). Ten of these cases were purposively selected for detailed analysis on the basis of educational relevance. In these 10 videos, the most salient error pattern assigned by the author was a small or poorly mobile flap in 5 cases, traction-vector misalignment in 4, and inadequate pivoting in 1; these proportions describe the selected sample only. A continuous capsulorhexis was completed in all 10 cases, and in-the-bag intraocular lens implantation was achieved in all 50 procedures. In an inter-observer analysis by two blinded assessors, agreement was high for the final outcome and low for the primary error pattern.

CONCLUSION

This video-based framework proposes a structured educational approach to early biomechanical control during capsulorhexis and may provide a practical adjunct for surgical training and structured video review.