Real-time intraoperative dynamics of white cataract—intraoperative optical coherence tomography–guided classification and management

Abstract

Purpose: To evaluate morphological characteristics and intraoperative dynamics of different types of white cataract using intraoperative optical coherence tomography (iOCT). Setting: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. Design: Prospective interventional study. Methods: Fifty eyes with white cataract undergoing phacoemulsification were evaluated. The primary outcome measure was the classification of white cataract based on morphology and intraoperative dynamics on iOCT. The secondary outcome measure was rhexis-related complications. Results: Four types of white cataract were identified based on iOCT—type I (9 eyes), type II (3 eyes), type III (24 eyes), and type IV (14 eyes). Type I had regularly arranged lamellar cortical fibers, type II had continuous hyperreflective bands of cortical fibers with intralenticular clefts, type III had intralenticular clefts combined with areas of homogenous ground-glass appearance, and type IV had homogenous ground-glass appearance of the anterior lens cortex. Capsulorhexis in type I cataract was uneventful. In type II cataract, cortical bulge was observed in the anterior chamber on creating the initial nick, indicating raised intralenticular pressure (ILP) with an imminent risk of rhexis extension. A bimanual irrigation/aspiration was performed until lowering of ILP was observed on iOCT. In types III and IV, fluid release was observed on initiation of rhexis leading to partial (type III) or complete (type IV) lowering of ILP, with a mild-moderate risk of capsulorhexis extension. A continuous curvilinear capsulorhexis was achieved in all cases, with no case of posterior capsular tear or vitreous loss. Conclusions: Intraoperative OCT helped elucidate intraoperative dynamics of the spectrum of white cataracts and facilitates completion of capsulorhexis.

What Is the Impact of Intraoperative Microscope-Integrated OCT in Ophthalmic Surgery? Relevant Applications and Outcomes. A Systematic Review

“…Thirty-one articles were excluded: 19 were not written in English, 9 were review papers, and 3 were ex vivo studies. After full-text evaluation, 82 studies discussing the use of MI-OCT in ophthalmology were included [ 13 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , ...…”

“…Titiyal et al evaluated 50 senile white cataracts with MI-OCT, proposing a new classification system and management strategy for each type of cataract [ 54 ]: Type I cataract, with regularly arranged cortical fibres without raised intra-lenticular pressure (ILP). Type II cataract, with anterior cortical convexity and raised pre-operative ILP, but without fluid release and ILP resolution at the begin of capsulorhexis.…”

“…In a type II cataract, there is an increased risk of rhexis extension, and the authors suggested performing bimanual aspiration/irrigation until ILP lowering is observed with MI-OCT. However, in types III and IV, there is a mild–moderate risk of capsulorhexis extension and so the above-mentioned procedure is not required [ 54 ].…”

The Emerging Role of Anterior Segment Optical Coherence Tomography in Cataract Surgery: Current Role and Future Perspectives

“…Therefore, similar to the previous observations, the iOCT was also very quick in demonstrating the extent of fluid collection, and in prompting a rescue strategy to minimize the capsular runaway complications. 17 However, these studies have hardly stated the possible natural progression of intralenticular changes, because not all of these white and/or mature cataracts may possess significantly disorganized lens fibres and liquefied material at the time of surgery. Hence, to fill these gaps in our understanding, we worked on mature cataracts to organize the possible intralenticular changes in the preoperative period on a modified posterior segment OCT. (We modified the posterior segment OCT to an anterior segment OCT by placing a +20 D lens along its aperture.)…”

Diagnostic imaging versus surgical procedure: intra- and postoperative OCT evaluation of sutureless scleral-fixated intraocular lens implantation and possible related complications

“…Posterior chamber mono or multifocal lenses cannot be verified in a precise and unique way; in particular, should posterior capsule rupture occur, the lenses that are positioned in the ciliary sulcus cannot be assessed. Thus, AS-OCT loses its usefulness after surgery is performed; in fact, whilst the anterior chamber is always easily assessed, the posterior chamber is never accessible [25].…”