Intraoperative complications in

intumescent cataract surgery using

a phaco capsulotomy technique
Selim Genc, MD, Emre Guler, MD, Hanefi C akr, MD, Yusuf Ozerturk, MD
PURPOSE: To evaluate intraoperative complications of a modified phaco capsulotomy technique
and the ophthalmic viscosurgical device (OVD)assisted capsulorhexis in eyes with intumescent
white cataract.
SETTING: Lutfi Krdar Kartal Eye Training and Research Hospital, Department of Ophthalmology,
Istanbul, Turkey.
DESIGN: Comparative randomized case study.
METHODS: Eyes of patients with intumescent white cataract were divided into 2 equal groups. After
the anterior capsule was stained with trypan blue, Group 1 received a modified phaco capsulotomy
technique and Group 2 received a high-viscosity OVDassisted capsulorhexis. The OVD used was
sodium hyaluronate 2.0% (Protectalon 2.0%) Main outcomes were the capsulorhexis diameters,
the deviations from the target diameter, and intraoperative complications.
RESULTS: Eighty eyes of 80 patients were enrolled. There was a deviation from the target
capsulorhexis
diameter in 15 eyes (11 oversized, 4 undersized) in Group 1 and in 20 eyes (16 oversized,
6 undersized) in Group 2. Capsule tears during capsulorhexis were observed in 2 eyes in Group 1,
and the surgery was changed to extracapsular cataract extraction (ECCE) in 1 eye. In Group 2,
capsule tears during capsulorhexis occurred in 22 eyes and 20 of these were managed with ECCE.
CONCLUSION: The modified phaco capsulotomy technique might reduce the risk for capsule tear
during capsulorhexis, leading to safe cataract surgery in cases of intumescent cataracts.
Financial Disclosure: None of the authors has a financial or proprietary interest in any material or
method mentioned.
J Cataract Refract Surg 2016; 42:11411145 Q 2016 ASCRS and ESCRS
Online Video
Despite the advances in cataract surgery since the
advent of phacoemulsification, intumescent cataract remains
a challenge for ophthalmic surgeons regardless of
their level of experience. Intracapsular pressure might
be elevated in an eyewith intumescent cataract through
the liquefaction of the cortex and an underlying brunescent
nucleus. Creating a safe continuous curvilinear
capsulorhexis (CCC) without further anterior capsule
complications is the most challenging step of cataract
surgery in these cases.1,2 Even after capsule staining
with trypan blue increases visualization and increases
the stiffness of the anterior capsule,3 capsule puncture
can result in uncontrollable extension of the opening
of the anterior lens capsule. When this occurs, the
tearing might extend beyond the equator and lead to
more serious complications, such as zonule rupture or
posterior capsule tear, vitreous loss, nucleus drop, and
posterior displacement of the intraocular lens (IOL).4,5
Variousmethods have been described to enhance the
outcomes in these cases and tominimize the risk profile
of an uncontrolled opening of the anterior lens
capsule.6
11 Despite this, the complications in intumescent cataracts continue to occur. Recently, outcomes of a new
technique, phaco capsulotomy, have been reported to be favorable in eyes with intumescent cataract.
12 The present study compared this recentsurgical approach with a high-viscosity ophthalmic viscosurgical device
(OVD)assisted CCC and evaluated Q 2016 ASCRS and ESCRS Published by Elsevier Inc.
http://dx.doi.org/10.1016/j.jcrs.2016.06.025 1141
0886-3350
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