Continuous Curvilinear Capsulorhexis (CCC) is a crucial step in cataract surgery, involving the creation of a smooth, circular opening in the anterior capsule of the lens. This step requires precision and skill, and the choice of instruments can significantly impact the outcome. Two commonly used tools for CCC are the irrigating cystotome and capsulorhexis forceps. Here, we explore the differences, advantages, and considerations for choosing between these two instruments.

The irrigating cystotome is a specialized instrument combining a sharp cystotome tip with irrigation capabilities. This dual function allows the surgeon to create and manipulate the capsular flap while maintaining the anterior chamber’s stability with a continuous flow of balanced salt solution (BSS). The design of the irrigating cystotome features a sharp tip for puncturing and tearing the capsule, coupled with an irrigation port to maintain chamber stability. It is particularly useful in maintaining a stable anterior chamber during the CCC process. The integration of irrigation helps keep the anterior chamber deep and prevents collapse, providing a safer environment for delicate maneuvers. During the procedure, the surgeon uses the sharp tip of the irrigating cystotome to initiate the capsulorhexis and then continues to guide the tear in a circular motion. The continuous irrigation ensures that the anterior chamber remains stable throughout the procedure, reducing the risk of complications.

Capsulorhexis forceps are fine, delicate instruments designed specifically for grasping and tearing the lens capsule to create a continuous, smooth opening. These forceps come in various designs, including straight and curved tips, to suit different surgical preferences. The capsulorhexis forceps have fine, pointed tips for precise grasping and tearing of the capsule. They provide excellent control and precision, making them ideal for creating a well-centered and perfectly sized capsulorhexis. The tactile feedback and control offered by forceps are unparalleled, allowing for meticulous adjustments during the tear. In the procedure, the surgeon uses the forceps to pinch and tear the capsule, carefully guiding the tear in a continuous circular motion. This method offers excellent precision and control, enabling the creation of a perfectly shaped capsulorhexis.

The key differences between these instruments lie in their design and functionality, chamber stability, control, and precision. The irrigating cystotome combines a sharp tip for cutting with an irrigation port to maintain chamber stability, whereas the capsulorhexis forceps have fine, pointed tips designed solely for grasping and tearing the capsule. The irrigating cystotome maintains anterior chamber depth through continuous irrigation, while the capsulorhexis forceps rely on the surgeon’s technique to maintain chamber stability without additional irrigation. In terms of control and precision, the irrigating cystotome offers stability but may require more skill to control the tear precisely. On the other hand, the capsulorhexis forceps provide excellent control and tactile feedback, ideal for precise, delicate maneuvers. The choice of instrument can also depend on the surgeon’s skill and comfort, patient factors, and the surgical environment.

Surgeons should choose the instrument they are most comfortable and skilled with to ensure the best outcome. In cases with compromised zonules or shallow anterior chambers, the irrigating cystotome may offer additional stability. Access to specific instruments and the overall setup can also influence the choice between the two tools. Both instruments play a vital role in ensuring a successful CCC and ultimately, a successful cataract surgery.