Problems and techniques associated with cataracts
A variety of challenges can be caused by white cataracts during an eye surgery. People with cataracts always have dense lens nucleus and suffer more risks of surgery complications. The good news is that modern techniques and devices can help cataract patients lower surgery risks and improve outcomes.
Examination of the retina and optic nerve is often impossible in cataract patients because these white cataracts cover the posterior pole of the eye. Fortunately, ultrasound imaging can provide a clear view of the posterior segment. In addition, flashlight testing can be used to detect gross pathology of the optic nerve or retina.
White cataracts also bring opacity in the eye, which precludes biometry. An A-scan ultrasound is usually used to measure axial length in cataract patients. Cataract patients are unable to fixate to locate the visual axis, so that keratometry measurements should be centered over the pupil. Cataract patients are always accompanied by uveitis, narrow angles or vascular disease, which can be detected by careful slit lamp examination of the anterior segment.
However, white cataracts can block red reflex from the surgical microscope so that visualization of the clear anterior capsule is quite difficult. A method to solve this problem is the use of trypan blue dye, which will be applied to the anterior capsule under air or viscoelastic. Visualization of the anterior capsule thus can be enhanced by the dye. One side effect of dye administration is that the lens’s elasticity may be deceased.
Capsulorrhexis creation in cataract patients also involves more risks, because the white cataracts can sometimes by liquefied and lead to leakage of white, milky fluid. This leakage can even impair visualization at the time of the opening of the capsular bag. This fluid may also bring pressure gradient, which leads to severe radialization of the rhexis edge.