Affiliation:
1. Cataract and Refractive Surgery, Giridhar Eye Institute, Kochi, Kerala, India
Abstract
Intumescent white cataracts are a challenge for novice and experienced surgeons alike. Creating a continuous curvilinear capsulorhexis may pose a problem in these cataracts due to many factors like increased intra capsular pressure, absence of red reflex, poor visibility, fragile or calcified anterior capsule.[1] These cataracts tend to have a shallow anterior chamber and presence of fluid vacuoles or sectoral markings in subcapsular area which can be seen on slit lamp biomicroscopy.[2] Argentinian flag sign, which is a radial tear in anterior capsule, can occur while creating capsulorhexis, due to raised intracapsular pressure.[3] Radial tears extending to the equator, makes phacoemulsification unsafe, since it may lead to further complications such as extension of the tear to posterior capsule, nucleus drop in vitreous cavity and difficulty with IOL placement. This video demonstrates the steps of 2 staged capsulorhexis, to prevent radial extension while operating a type 1 (liquified cortex) intumescent cataract and type 2 (no liquified cortex, only tense fibres) intumescent cataract.[4]