What to do with limited view: The intumescent cataract

In 1991, 2,967 consecutive cataract cases were analyzed in a prospective, observational study for the incidence of intumescent cataract. Thirty four (1.15%) of the cases were mature intumescent lenses. A deliberately small continuous curvilinear capsulorhexis (CCC) enlarged secondarily by the two-stage continuous curvilinear capsulorhexis (2-CCC) technique was the anterior capsulotomy approach of choice. Depending on the liquidity of the lens material, liquid cortex was aspirated using a 26- or 30-gauge needle before capsulorhexis or through a small CCC. Because of loss of CCC control, a can-opener capsulotomy was used in three of the 34 cases before being converted by the 2-CCC technique. The rigid nucleus was usually extracted using the down-slope nucleofractis phacoemulsification technique. Four (11.7%) of the 34 intumescent cases had anterior capsule tears during capsulotomy. Successful in-the-bag lens implantation was achieved in all cases. We describe a technique of CCC, 2-000, and down-slope sculpting nucleofractis phacoemulsification to manage intumescent cataracts.