Intumescent white cataracts have liquefied lens cortex which creates a high intra-lenticular pressure and this causes a force on the lens capsule as you attempt the capsulorhexis. This can lead to capsule runout and the dreaded Argentinian flag sign. For most of these cases, using a needle decompression technique can really facilitate the surgery and lessen the risks of capsular radialization. This video shows an anonymous resident surgeon doing a great job with this technique. What is your approach to intumescent white cataracts?
Doctor, I’ve been having ideas of a better way to deal with this problem. What I’ve noticed is that this technique if the pressure differential is too great between the capsule and the chamber, even a needle puncture can immediately cause the puncture to split radially. I’ve seen a few videos of them going completely equatorial. I think you guys need a tool strictly just to deal with capsules that are under high pressure. A good analogy to what I’m thinking about would be similar to how a cookie cutter shark works. you need a tool that is about a 1mm circle in diameter that plays two roles. #1 it acts as a very very weak vacuum. #2 it has to cut a circular opening in the capsule tissue very quickly while maintaining this extremely weak vacuum. after the opening is made it may be best to allow the light vacuum of this tool to slightly depressurize the bag before removing it. after this you should be able to use this 1mm rhexis to clear some of the cortex away. Then from here you guys know exactly what to do. But this needle method can be dangerous if the previously mentioned pressure conditions exist.
Everytime I try needle decompression I aspirate nothing! How can you tell when it is needed?