Phacoemulsification of white mature cataracts

PURPOSE: To evaluate the intraoperative difficulties associated with phacoemulsification of white mature cataracts and develop a strategy for consistently achieving continuous curvilinear capsulorhexis (CCC) in these cases. SETTING: Raghudeep Eye Clinic, Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: This prospective study comprised 60 eyes of 60 patients with senile white mature cataract. Mean follow-up was 7 months. Detailed preoperative and intraoperative notes were made including intraoperative subjective assessment of the intracapsular pressure and cataract hardness. A small capsulorhexis was attempted initially. Endophacoemulsification was performed using the stop, chop, chop, and stuff technique. The capsulorhexis was enlarged before intraocular lens implantation. An initial cut in the capsulorhexis margin was made with a cystotome needle while a spatula supported the anterior capsule. The capsulorhexis was then enlarged with forceps. RESULTS: A CCC was achieved in 57 eyes (95%). Intracapsular pressure was judged to be raised in 24 eyes (40%). Of these, CCC was accomplished in 21 eyes (88%). Statistical analysis confirmed that raised intracapsular pressure was a significant factor. Capsule opacification or plaque was detected at the end of the surgery in 20 eyes (33%); 50% of the nuclei were of grade 5 hardness. CONCLUSION: If a CCC can be achieved, the results of white cataract phacoemulsification are comparable to those of routine cataract surgery. When using the two-stage technique, one should be prepared to deal with a hard cataract through a small capsulorhexis.