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Be ready for anything when treating white cataracts

Issue: December 25, 2011

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Jonathan B. Rubenstein

NEW YORK — General techniques apply to treating white cataracts, even though there are differences among the various types, a speaker told colleagues here.

"There can be a mature white lens with a very hard nucleus behind it. There can be a cortical cataract causing most of the whitening, sometimes with a dense white capsular adhesion. There can be an intumescent swollen cataract that's under pressure or tension or the liquefied Morgagnian cataract, essentially with a very hard nut of nucleus floating in the center," Jonathan B. Rubenstein, MD, said at OSN New York 2011.

One general technique is to decompress the capsular bag if it is thought to be under pressure in one of the swollen lenses.

"You do that by pressurizing the anterior chamber," Dr. Rubenstein said, using viscoelastic "to make the pressure outside of the capsular bag greater than the pressure within the lens. Then puncture and decompress very slowly."

Staining the capsule with trypan blue dye is also helpful, he said.

Surgeons should anticipate there being very little cortical matter behind the dense lens once it is removed, Dr. Rubenstein said.

"Often you don't know what to expect. You have to be in a position where you can deal with anything that presents afterward," he said.

• Disclosure: Dr. Rubenstein is a consultant for Alcon Laboratories, Allergan and Bausch + Lomb.

For these white cataracts, you need to determine whether there is any history of cataract during childhood, keeping in mind that it might be a posterior polar cataract. If there is such a history, and if you hydrodissect, you may wave “bye” to the lens as it goes posteriorly due to the decreased integrity of the posterior capsule. Sometimes with these white cataracts, I will viscodissect instead of hydrodissect. That is just a little pearl.

– Rosa M. Braga-Mele, MD, FRCSC
OSN Cataract Surgery Section Editor
Disclosure: Dr. Braga-Mele has no relevant financial disclosures.