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 surge ry, and their acoustic structure was analyzed with standardized A-scan echo graphy. 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 f or a period of 9 months. Main Outcomes Measures: The A-scan acoustic structure of white cataracts; s uccessful accomplishment of capsulorrhexis; mean phacoemulsification time, power, and energy; intraoperative and postoperative complications of phacoe mulsification; 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 catar acts with voluminous nuclei, little amount of whitish solid cortex, and low internal acoustic reflections (49 eyes), and type III included white catar acts with fibrosed anterior capsule and low internal echospikes (7 eyes). C ircular capsulorrhexis was completed in 79 eyes and was significantly less successful in eyes with type intumescent, white cataracts compared with typ e II white cataracts (P = 0.0034). Mean phacoemulsification time and energy were higher in type II and type III white cataracts. Posterior capsule rup ture occurred in ten eyes, and three of these eyes were complicated by vitr eous loss. In 95 eyes, the posterior chamber lens was implanted in the caps ular 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 pos toperative visual acuity was 20/30. Conclusion: Current phacoemulsification techniques can safely manage eyes w ith senile white cataracts. The increased risk of difficulty with continuou s capsulorrhexis in type-I and type-III white cataracts and the substantial nuclear hardness in type-II and mainly type-Ill white cataracts would sugg est that current phacoemulsification techniques might not be as successful in these patients as they are in ordinary earlier cataracts.