Capsulorhexis in White Intumescent Cataracts: The Five Commandments to Follow.

ABSTRACT

We describe a surgical technique for achieving a successful capsulorhexis in white intumescent cataracts. Raised intralenticular pressure is responsible for the high incidence of peripheral extension of the capsulorhexis (Argentinian Flag Sign) in intumescent cataract surgery. Swollen anterior and posterior sub-capsular cortex is responsible for the high intralenticular pressure. We present surgical strategies in the form of five commandments, which would ensure better success rates in achieving capsulorhexis in intumescent cataracts. These five commandments are based on the surgical principles of maintaining positive pressure in the anterior chamber and performing a two staged sequential active decompression of the swollen capsular bag and a two staged capsulorhexis. These strategies aim at gradual decompression of the swollen capsular bag, which will ensure a less tense anterior capsule and better control over the tearing anterior capsule