Mini-rhexis for white intumescent cataracts

purpose: to compare the intraoperative safety of two techniques of capsulorhexis for intumescent white cataracts: traditional one-stage continuous curvilinear capsulorhexis and two-stage continuous curvilinear capsulorhexis. methods: this prospective comparative randomized study included two groups: the 1-ccc group (11 patients) received traditional one-stage continuous curvilinear capsulorhexis with 5-6 mm diameter, and the 2-ccc (13 patients) group received a deliberately small continuous curvilinear capsulorhexis that was secondarily enlarged, or a two-stage continuous curvilinear capsulorhexis. patients were stratified according to cataract subset, which was characterized echographically. six patients were considered as type 1, fifteen as type 2 and three as type 3. type 1 included intumescent white cataracts with cortex liquefaction and extensive internal acoustic reflections, type 2 included white cataracts with voluminous nuclei, a small amount of whitish solid cortex, and minimal internal acoustic reflections, and type 3 included white cataracts with fibrous anterior capsules and few internal echo spikes. results: with the one-stage technique, 46.15% of patients had leakage of the liquefied cortex; in addition, the surgeon perceived high intracapsular pressure in 61.53% of cases. anterior capsule tears occurred in 23.07% of cases, discontinuity of capsulorhexis in 30.79% of cases and no posterior capsular rupture occurred. with the two-stage technique, leakage of the liquefied cortex occurred in 45.45% of cases; additionally, the surgeon perceived high intracapsular pressure in 36.36% of cases. no anterior capsule tears, discontinuity of capsulorhexis or posterior capsular rupture occurred. considering each cataract subset, there was a higher incidence of leakage for type 2 as compared to types 1 and 3. conclusions: two-stage continuous curvilinear capsulorhexis helps prevent unexpected radial tears of the initial capsulotomy from high intracapsular pressure