We describe a novel intraoperative technique of measuring and creating an adequate size continuous curvilinear capsulorhexis (CCC) in phacoemulsification, using a dented cystitome as the ruler. A pair of curved tenotomy scissors is used to create a dent on the cystitome at a distance of 2.5 mm length (i.e., half of the desired approximate capsulorhexis diameter). The dented cystitome is used as a guide for making a CCC of approximately 5 mm diameter, which is considered adequate for phacoemulsification. This method of measuring the capsulorhexis helps in achieving a well centered and stable intraocular lens with a 360° overlap of the optic edge by the anterior capsular rim in the postoperative period. Using a dented cystitome for capsulorhexis mandates reliable and consistent results in the hands of the novice as well as the experienced surgeons.

Purpose: Pseudoexfoliation is an age-related fibrillopathy characterized by the deposition of fibrillar material in the eye with an increased risk of complications during cataract surgery. Aim was to study visual outcomes and complications in patients with pseudoexfoliation undergoing manual small-incision cataract surgery (MSICS). Methods: Prospective observational study was performed on 152 patients with pseudoexfoliation above 50 years undergoing MSICS in a tertiary hospital from December 2016 to November 2017. Intraoperative and postoperative complications were documented with follow-up on postoperative day 1, 1 st week, 1 st month, and 3 rd month. Results: Preoperative small pupil was noted in 49 eyes (32.2%), and 19 (12.5%) required intraoperative measures. Intraocular complications noted were zonular dialysis in five (3.3%), posterior capsular rupture in one (0.7%), and iridodialysis in one (0.7%). On postoperative day 1, the most common complication was corneal edema in 134 patients but clinically significant in only 23 (15.1%). Postoperative complications at 3 months were irregular pupil in 17 cases and decentered IOL in three cases. Intraocular pressure decreased with each visit [preoperative mean: 14.39 (±3.4) and 13.37 (±2.0) 12.53 (±1.4) mm Hg at 1 and 3 months, respectively]. There was a significant improvement in vision from the first day mean pinhole vision of 0.26 (±0.24) to mean best corrected visual acuity (BCVA) of 0.09 (±0.22) and 0.07 (±0.22) at 1 and 3 months, respectively. Mean endothelial cell loss was 193.16 (7.79%) and 266.01 (10.68%) at 1 and 3 months, respectively. Conclusion: Pseudoexfoliation has an increased risk of complications during cataract surgery. MSICS gives good outcomes in terms of visual recovery and postoperative outcomes.