title: Mini-rhexis for white intumescent cataracts.
abstract: OBJECTIVE
  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, sudden radialization of the CCC and other intraoperative complications due to high intracapsular pressure, thus providing a safe cataract surgery in cases of white cataracts. These findings were supported by ultrasonography.
authors.affiliation: Ophthalmology Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Newton
authors.initials: N
authors.lastname: Kara-Junior
authors.forename: Marcony Rodrigues
authors.initials: MR
authors.lastname: de Santhiago
authors.forename: Andrea
authors.initials: A
authors.lastname: Kawakami
authors.forename: Pedro
authors.initials: P
authors.lastname: Carricondo
authors.forename: Wilson Takashi
authors.initials: WT
authors.lastname: Hida
mesh_terms: D000368:Aged; D019923:Capsulorhexis / Q000379:methods*; D002386:Cataract / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007903:Lens Capsule, Crystalline / Q000000981:diagnostic imaging / Q000601:surgery; D007904:Lens Cortex, Crystalline / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography