Phacomulsification in senile white mature cataracts;its safety and efficacy

Abstract

Abstract
 Purpose 
 To evaluate the intraoperative difficulty, complications and post operative outcome in patients with white mature cataracts undergoing phacomulsification and foldable intraocular lens implantation and to develop a strategy for achieving continuous curvilinear capsulorhexis in these cases.
 Study design
 Descriptive case series
 Place and duration 
 Ophthalmology department of Holy family hospital, Rawalpindi in six months interval since January 2017 to June 2017
 Material and Methods 
 50 Patients who had senile white mature cataract were enrolled in this prospective study .Detailed preoperative and intraoperative notes were made. A small capsulorhexis was attempted initially after staining capsule with trypan blue .An initial cut was made with cystotome and it was enlarged with utrata forceps. Endophacomulsification was done with stop and chop technique. Intraoperative difficulties related to continuous curvilinear capsulorhexis, phacomulsification and post operative visual outcomes were analyzed.post operative examinations were done at day 1,1st week,1st month and 3rd month.
 Results
 There were 28 males (56%) and 22 females (44%).The mean age was 63.18±7.997 standard deviation years(48-78).The mean preoperative best corrected visual acuity BCVA was 0.0276±0.013 (SD)Snellen, decimal(0.01-0.05) and the mean post operative BCVA was 0.638±0.305 (SD) Snellen, decimal(0.1-1.0) .Mean phaco time was 4.08±1.03 (SD)mins(2.08-6.66).The mean preoperative intraocular pressure IOP was 15.90±1.799 (SD)mmHg (12-22) and mean post op IOP was 11.98±2.035 (SD) mmHg(10-18) .Posterior capsular rupture occurred in 3 (6%) , vitreous loss occurred in 1 (2%) patients. 5 (10%) cases were converted to extra capsular cataract extraction (ECCE). Postoperatively 10 (20%) patients had transient corneal edema, 3 patients (6%) had persistent corneal edema and corneal burn treated with steroids and hyper osmotic agents.
 Conclusion 
 The intraoperative and postoperative complications rate is higher in white mature cataracts. White mature cataract is a challenge for cataract surgeon, yet by means of additional dyes and proper techniques and expertise, the rate of complications can be reduced.
 Keywords
 Phacomulsification, continuous curvilinear capsulorhexis, senile mature cataract, trypan blue, posterior capsular rupture, persistent corneal edema