Preoperative 532 double frequency YAG anterior capsulotomy in hypermature cataracts

Phacoemulsification in hyper-mature cataracts is a challenge due to high intra-lenticular pressure, resulting in the capsulorhexis extending to the periphery. A continuous curvilinear capsulorhexis (CCC) is crucial to uncomplicated, safe and successful phacoemulsification and posterior chamber intraocular lens (IOL) implantation. Achieving a CCC in eyes with white hyper-mature cataract is challenging due to high intra-lenticular pressure and risk of extension of capsulorhexis (Argentinian flag sign). Various techniques such as double capsulorhexis, phacocapsulorhexis, massaging, anterior capsular puncture with a needle or YAG laser and femtosecond laser capsulorhexis have been described to prevent this complication.