The cortical cataract changes look like spokes of a wheel and they can cause issues for both the patient and the ophthalmologist. The patient notes poor quality of vision with a lot of glare from on-coming light sources such as sunrise / sunset and also the headlights of opposing car traffic.
For the cataract surgeon the challenge is visibility during capsulorhexis creation as well as during nucleo-fractis phaco techniques. The key in performing the capsulorhexis is to only let go of the capsule in order to re-grab when the leading edge is in a position of good visibility. By waiting until the leading edge is between to opaque spokes, there is less chance of losing the capsulorhexis. We can also use capsular dye such as trypan blue to aid in visibility, but in most cases this is not needed.
In this case we also flip the nucleus out of the capsular bag in order to facilitate phaco-aspiration. Since the cataract is primarily cortical in nature, the nucleus is not very dense and it is easily aspirated from the anterior chamber. During cortex removal we note that the areas of cortical opacity and more fibrous in nature and tend to pull off in a large sheet.
Click below to watch the video of how we deal with opaque cortical spokes: