Phacoemulsification of white mature cataracts

Ultrasonographic classification and phacoemulsification of white senile cataracts

OBJECTIVE

To classify the white senile cataracts and report the results of phacoemulsification of white cataracts.

DESIGN

Prospective, noncomparative case series.

PARTICIPANTS

One hundred eyes were included.

INTERVENTION

White cataracts were examined biomicroscopically before surgery, and their acoustic structure was analyzed with standardized A-scan echography. White cataract surgery was performed with phacoemulsification via a superior temporal near-limbus corneal approach using a bimanual divide-and-conquer or stop-and-chop technique. Patients were followed after surgery for a period of 9 months.

MAIN OUTCOMES MEASURES

The A-scan acoustic structure of white cataracts; successful accomplishment of capsulorrhexis; mean phacoemulsification time, power, and energy; intraoperative and postoperative complications of phacoemulsification; and visual acuity at 9 months after surgery.

RESULTS

White senile cataracts were categorized into three different types. Type I included intumescent, white cataracts with cortex liquefaction and high internal acoustic reflections (44 eyes), type II included white cataracts with voluminous nuclei, little amount of whitish solid cortex, and low internal acoustic reflections (49 eyes), and type III included white cataracts with fibrosed anterior capsule and low internal echospikes (7 eyes). Circular capsulorrhexis was completed in 79 eyes and was significantly less successful in eyes with type I intumescent, white cataracts compared with type II white cataracts (P = 0.0034). Mean phacoemulsification time and energy were higher in type II and type III white cataracts. Posterior capsule rupture occurred in ten eyes, and three of these eyes were complicated by vitreous loss. In 95 eyes, the posterior chamber lens was implanted in the capsular bag and in five eyes in the sulcus. After surgery, a transient corneal edema developed in 31 eyes. At the final 6-month examination, the mean postoperative visual acuity was 20/30.

CONCLUSION

Current phacoemulsification techniques can safely manage eyes with senile white cataracts. The increased risk of difficulty with continuous capsulorrhexis in type-I and type-III white cataracts and the substantial nuclear hardness in type-II and mainly type-III white cataracts would suggest that current phacoemulsification techniques might not be as successful in these patients as they are in ordinary earlier cataracts.

Combined phacoemulsification--vitrectomy surgery: technique, indications and outcomes

PURPOSE AND METHODS

Cataract extraction may be combined with vitrectomy to improve the operative view and/or enhance post-operative rehabilitation. A retrospective review of the records of all patients undergoing combined phacoemulsification and vitrectomy procedures since 1993 was performed. Surgical technique is discussed.

RESULTS

Fifty operations on 49 patients are described. Visual acuity improved overall (mean LogMAR acuity 1.58 +/- 0.74 pre-operatively and 1.17 +/- 0.76 LogMAR post-operatively), with 57% of patients having improved acuity post-operatively. Operative complications were few and post-operative complications were acceptable given the severity of the posterior segment disease.

CONCLUSIONS

Combined phacoemulsification-vitrectomy surgery is a viable option in the management of posterior segment disease in the presence of cataract. It has a number of advantages over other approaches, and can be combined with intraocular lens insertion into the capsular bag in most cases.

Surgical techniques for difficult cataracts

This article reviews some of the advances that have taken place in the surgical techniques for difficult cataracts such as rock-hard, white, and posterior polar cataracts. Fashioning a central space, modified chopping maneuvers, and creation of multiple small fragments have enabled the surgeon to consistently achieve a successful outcome. A judicious combination of chop and separation movement in a step-by-step manner reduce the stress of the procedure and make it safer. Raised intracapsular pressure and poor visibility are dealt with through various innovative techniques. Use of high-viscosity sodium hyaluronate and double capsulorhexis allow the surgeon to achieve capsulorhexis with a high success rate. A controlled and gentle approach to phacoemulsification has proven to be the key factor for success in posterior polar cataracts.