Completing phaco following anterior capsular tear.

A primary tear-out of the capsulorrhexis or a later anterior capsule tear occurs in less than 1% of phacoemulsification procedures (Marques et al., 2006). It is a relatively uncommon complication but a hazardous and important one, although comparatively little has been published on its management. With the nucleus still in the bag at this stage, the surgeon is faced with the sizeable challenge of completing surgery without propagating a wrap-around tear to the posterior capsule. These are perilous conditions to face, but by using the right techniques the surgeon can still prevail. There is a clear set of principles that are based on self-knowledge of the surgeon's own skills and experience, combined with their understanding of how to control the forces acting on the tear and the tolerances of the capsular bag to surgical manipulation. Applying these principles in practice has enabled the development of a range of techniques now available to safely remove the nucleus under these challenging conditions. However, by far the most important principle of all is that if in doubt, not to proceed.