Management of Intumescent White Cataract

The Intumescent white cataracts  pose challenges in every step of the cataract surgery. The capsulorhexis is the most challenging step followed by nucleus management.The capsulorhexis  are prone to anterior capsular radial tear extension (The Argentinean flag sign ).So the three stage capsulorhexis is advisable to prevent anterior capsular radial tear extension. Three Stage Capsulorhexis

Stage 1: Small Central Capsulorhexis: Cohesive viscoelastics is preferable for such cases. Initially a curvilinear nick is given and capsular flap is folded and small capsulorhexis is made by shearing and tearing forces.

Stage 2: Capsular bag is de bulked by aspirating cortical matter.

Stage 3: Small capsulorhexis Enlargement This is enlarged by forceps after giving a curvilinear nick in margin of small capsulorhexis

If the capsulorhexis is successful then nucleus can be managed either by phacoemulsification or manual small incision cataract surgery. As there is no good cortical support so slight mishandling may be disastrous.

If  the capsulorhexis is not  successful  then its better to manage nucleus by manual small incision cataract surgery to avoid serious complications like posterior capsular rent or nucleus drop. If nucleus is very hard then manual small incision cataract surgery advisable. 

Intumescent Cataract : Phaco With 3 Stage Capsulorhexis

Despite all precautions: Argentinean Flag Sign encountered. It’s not end of the world. The capsular tear is converted in a can opener capsulotomy. If case is planned for phacoemulsification then it’s better to convert in MSCIS (Manual Small Incision Cataract Surgery). Phacoemulsification in extended or non intact capsulorhexis could be risky affair. Conditions like hyper mature morgagnian cataracts or hard nuclear cataract with no or very little cortical support might further increase the risk of the serious complications. Although some experience surgeon can complete phacoemulsification by exercising special precautions. It’s always better to covert to manual small incision cataract surgery to avoid complications like further posterior extension of capsular tear, zonulodialysis and nucleus drop. How to convert to MSICS please watch this (Link given below)                                     

 "Most Practical Way To Convert After Not Intact Capsulorhexis"

 https://youtu.be/t-jILM9NUMo.

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