Current opinion in ophthalmology · 2025
Surgical techniques for complicated cataracts: managing dense or white cataracts.
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Ahad Muhammad Ali, Almazyad Enmar M
Аннотация
PURPOSE OF REVIEW: To review recent advances in the surgical management of dense white cataracts, focusing on preoperative assessment, biometry, capsulotomy techniques, phacoemulsification systems, and surgical outcomes.
RECENT FINDINGS: Swept-source optical coherence tomography (SS-OCT) biometers now achieve nearly universal axial length measurements even in dense lenses, improving refractive predictability. Anterior segment OCT and Scheimpflug imaging facilitate detection of intralenticular fluid pockets and capsular thinning, guiding decompression strategies to prevent anterior capsule tears. Innovations in manual capsulorhexis, preoperative Nd:YAG (neodymium-doped yttrium aluminum garnet) decompression, and device-based techniques (precision pulse capsulotomy and selective laser capsulotomy) have improved reproducibility and reduced Argentinian flag sign incidence. Low-energy femtosecond laser-assisted cataract surgery further enhances endothelial safety in selected cases. In phacoemulsification, newer platforms with advanced fluidics and tips have decreased cumulative energy use, turbulence, and endothelial cell loss. For very dense nuclei, manual small-incision cataract surgery remains a practical alternative with lower endothelial trauma in specific settings.
SUMMARY: Advances in ocular imaging, biometry, capsulotomy, and phacoemulsification technology have significantly improved the safety and predictability of dense white cataract surgery. Incorporating these innovations into surgical practice has reduced the incidence of intraoperative complications, including anterior capsular tears, posterior capsule ruptures, and endothelial cell loss, while enhancing refractive outcomes.
RECENT FINDINGS: Swept-source optical coherence tomography (SS-OCT) biometers now achieve nearly universal axial length measurements even in dense lenses, improving refractive predictability. Anterior segment OCT and Scheimpflug imaging facilitate detection of intralenticular fluid pockets and capsular thinning, guiding decompression strategies to prevent anterior capsule tears. Innovations in manual capsulorhexis, preoperative Nd:YAG (neodymium-doped yttrium aluminum garnet) decompression, and device-based techniques (precision pulse capsulotomy and selective laser capsulotomy) have improved reproducibility and reduced Argentinian flag sign incidence. Low-energy femtosecond laser-assisted cataract surgery further enhances endothelial safety in selected cases. In phacoemulsification, newer platforms with advanced fluidics and tips have decreased cumulative energy use, turbulence, and endothelial cell loss. For very dense nuclei, manual small-incision cataract surgery remains a practical alternative with lower endothelial trauma in specific settings.
SUMMARY: Advances in ocular imaging, biometry, capsulotomy, and phacoemulsification technology have significantly improved the safety and predictability of dense white cataract surgery. Incorporating these innovations into surgical practice has reduced the incidence of intraoperative complications, including anterior capsular tears, posterior capsule ruptures, and endothelial cell loss, while enhancing refractive outcomes.