PHACOEMULSIFICATION OF WHITE MATURE CATARACTS

Purpose: To evaluate the intraoperative difficulties associated with p hacoemulsifisation of while mature cataracts and develop a strategy fo r consistently achieving continuous curvilinear capsulorhexis (CCC) in these cases. Setting: Raghudeep Eye Clinic, Iladevi Cataract & IOL Re search Centre, Ahmedabad, India. Methods: This prospective study compr ised 60 eyes of 60 patients with senile white mature cataract. Mean fo llow-up was 7 months. Detailed preoperative and intraoperative notes w ere made including intraoperative subjective assessment of the intraca psular pressure and cataract hardness. A small capsulorhexis was attem pted 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 ma rgin was made with a cystotome needle while a spatula supported the an terior capsule. The capsulorhexis was then enlarged with forceps. Resu lts: A CCC was achieved in 57 eyes (95%). Intracapsular pressure was j udged to be raised in 24 eyes (40%). Of these, CCC was accomplished in 21 eyes (88%). Statistical analysis confirmed that raised intracapsul ar pressure was a significant factor. Capsule opacification or plaque was detected at the end of the surgery in 20 eyes (33%); 50% of the nu clei were of grade 5 hardness. Conclusion: If a CCC can be achieved, t he results of while cataract phacoemulsification are comparable to tho se of routine cataract surgery. When using the two-stage technique, on e should be prepared to deal with a hard cataract through a small caps ulorhexis.