The Intumescent white cataracts pose challenges in
every step of the cataract surgery. The capsulorhexis is the
most challenging step followed by nucleus management.The
capsulorhexis are prone to anterior capsular radial
tear extension (The Argentinean flag sign ).So the three
stage capsulorhexis is advisable to prevent anterior
capsular radial tear extension. Three Stage Capsulorhexis
Stage 1: Small Central Capsulorhexis: Cohesive viscoelastics
is preferable for such cases. Initially a curvilinear nick
is given and capsular flap is folded and small capsulorhexis
is made by shearing and tearing forces.
Stage 2: Capsular bag is de bulked by aspirating cortical
Stage 3: Small capsulorhexis Enlargement This is enlarged by
forceps after giving a curvilinear nick in margin of small
If the capsulorhexis is successful then nucleus can be
managed either by phacoemulsification or manual small
incision cataract surgery. As there is no good cortical
support so slight mishandling may be disastrous.
If the capsulorhexis is not successful
then its better to manage nucleus by manual small incision
cataract surgery to avoid serious complications like
posterior capsular rent or nucleus drop. If nucleus is very
hard then manual small incision cataract surgery advisable.