Two stage capsulorhexis in intumescent white cataracts with anterior and posterior cortical debulking

Poster Details

First Author: V.Tewari INDIA

Co Author(s):    V. Biala              

Abstract Details

Purpose:

Capsulorrhexis which is a prerequisite for successful Phacoemulsification is not easy in Intumescent White Cataract (not milky cataract) with raised intralenticular pressure. We have devised a method with which we are able to complete the capsulorrhexis avoiding extension that may lead to Argentina Flag Sign.

Setting:

225 patients who had intumescent cataract with high intralenticular pressure were operated in our hospital (Tewari Eye Centre, Ghaziabad, INDIA) which is situated about 10 kms from New Delhi. We were able to complete rhexis in 218 cases.

Methods:

After staining the capsule with Trypan Blue and filling anterior chamber with Healon GV, a small rhexis not more than 2 mm in size was initiated in the centre. Anterior cortex and part of the central nucleus were debulked to make space for probe manipulation. Usually this step stabilized intra-lenticular pressure. Gentle hydro-dissection was done to flush out anterior cortical matter. However pressure was still high in some cases where direct chop was done, nucleus was fractured and posterior cortex was evacuated. This step stabilised the intra-lenticular pressure in such cases. Again, the anterior chamber was filled with visco-elastic and the small initial capsulorrhexis was converted into a larger one of desired size in a spiral manner.

Results:

We were successful in completing rhexis in 218 cases and were able to implant foldable lenses in the bag. In 3 cases, the capsulorrhexis had extended to the periphery. In 2 cases, the nucleus subluxated and in 1 case drop occurred, probable cause being high vacuum suction through a small capsular opening resulting in pull on the capsular bag. In the case where nucleus drop occurred, a probable cause could also have been preexisting zonular weakness due to old age (82 years) of the patient. In 1 case the capsule was torn during nuclear division through 2 mm capsulorrhexis.

Conclusions:

The basic aim of this technique is to tackle the pathology behind intumescent cataract i.e. increased intralenticular pressure leading to a taut and tense anterior capsule with greater convexity, and a shallow anterior chamber. With our results we can infer that this is a safe, effective and easily reproducible technique to combat the menace of intumescent cataract. FINANCIAL DISCLOSURE?: No