title: Phacoemulsification of brunescent and black cataracts.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of a step-by-step, chop in situ, lateral separation technique to remove brunescent and black cataracts.
  
  
  METHODS
  Iladevi Cataract and IOL Research Center, Ahmedabad, India.
  
  
  METHODS
  In this prospective study conducted between May 1997 and June 1998, 167 consecutive eyes were divided into 2 groups: Group 1, brunescent cataract (n = 123), and Group 2, black cataract (n = 44). Preoperative assessment included axial length (AL), slitlamp examination, corneal pachymetry, tonometry, and specular microscopy. During phacoemulsification performed by a single surgeon, a step-by-step, chop in situ, lateral separation technique was used to divide the nucleus. Intraoperatively, hydroxypropyl methylcellulose 2% was used and irrigation was by balanced salt solution (BSS). Postoperatively, all eyes were assessed at 1, 7, 30, 90, 180, and 360 days. The results were evaluated using regression analysis, the chi-square test, and the Student t test.
  
  
  RESULTS
  The mean follow-up was 14.4 months (range 6 to 35 months) in Group 1 and 13.0 months (range 6 to 32 months) in Group 2. The AL was significantly greater in Group 2 (P =.02). Corticapsular adhesions were present in 17.82% in Group 1 and 31.82% in Group 2. The mean cumulative dissipated energy was 2.03 and 3.12, respectively (P =.0005). Wound site thermal injury occurred in 16 eyes (13.01%) in Group 1 and 4 eyes (9.09%) in Group 2. No serious intraoperative or postoperative complications were noted. One day postoperatively, the mean rise in intraocular pressure was 1.76 mm Hg in Group 1 and 4.15 mm Hg in Group 2 (P =.012), and transient corneal edema was present in 24.40% and 34.10%, respectively. At 1 month, the endothelial cell loss was 10.06% in Group 1 and 9.22% in Group 2.
  
  
  CONCLUSIONS
  The step-by-step, chop in situ, lateral separation technique was effective and did not produce serious complications such as zonulysis or posterior capsule rupture. However, the incidence of wound site thermal injury and endothelial cell loss was greater than after emulsification of standard cataracts.
authors.affiliation: Iladevi Cataract & IOL Research Centre, Ahmedabad, India.
authors.forename: R
authors.initials: R
authors.lastname: Singh
authors.forename: A R
authors.initials: AR
authors.lastname: Vasavada
authors.forename: G
authors.initials: G
authors.lastname: Janaswamy
mesh_terms: D000085:Acetates / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications / Q000628:therapy*; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D065347:Hypromellose Derivatives; D007429:Intraocular Pressure; D008297:Male; D008747:Methylcellulose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D008903:Minerals / Q000627:therapeutic use; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D012449:Safety; D012965:Sodium Chloride / Q000627:therapeutic use; D014065:Tonometry, Ocular
chemical_list: D000085:Acetates; C030660:BSS solution; D004338:Drug Combinations; D008903:Minerals; D065347:Hypromellose Derivatives; D012965:Sodium Chloride; D008747:Methylcellulose