Cataract Quiz: how to rescue this case

This patient has an intumescent white cataract and we know that poses a risk of capsular run-out due to the pressurized and fluid-filled capsular bag. The resident surgeon in this case does a good job by keeping the anterior chamber pressurized at a level higher than the capsular bag pressure. Then the needle decompression is done well and then further effort is made to get even more of the liquefied cortex out of the bag. It goes very well until hydro-dissection…

For most intumescent white cataracts, hydro-dissection is not required because the cortex has already liquefied. Also we must be careful because we cannot see the fluid wave go across the posterior capsule because the white cataract is completely opaque. As the resident performs hydro-dissection, the cataract nucleus comes forward and places stress on the anterior capsular rim which causes a run-out of the capsulorhexis. How should you rescue this case now?

click below to learn from this video of rescuing this case and achieving a great outcome:

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