ASCRS Focus on Cataract Surgery
Surgical Management of Hard Cataracts
June 2022 Update
Dense and hard cataracts can cause a challenge for ophthalmologists in the operating room, and are often difficult to detect preoperatively. Without proper precautions and tools in place, the wrong move can result in a variety of complications, such as posterior capsule rupture or damange to the corneal endothelium.
In this updated Focus on Cataract Surgery guide, explore a variety of video and print resources on the surgical management of hard cataracts in order to minimize your chance of surgical complications.
ASCRS Surgical Films
Hard Cataract Surgical Technique
Explore these ASCRS Films on managing hard and dense cataracts.
Earn CME Credit
Phaco Fundamentals: Optimizing Phacodynamics for Brunescent and Challenging Cataracts
Participate and Claim CME at Your Convenience
Program will discuss principles for adjusting and optimizing phaco machine settings for both routine and complex cases. Special attention will be given to surgical strategies for rock hard cataracts and complicated cases.
The American Society of Cataract and Refractive Surgery designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credits™.
Learn More and Begin CME Activity
EyeWorld Article
Examining incision shapes in cataract surgery with dense lenses
by Liz Hillman, Editorial Co-DirectorWhile cataract surgery continually experiences advancement in technologies, techniques, implants, and calculations, one area that seems seldom discussed in comparison is incisions. A study that was published in late 2021 in JAMA Ophthalmology, however, took a look at the effect of incision shape on a cataract surgery complication in the setting of dense cataracts....
Read more on EyeWorld.org >>
EyeWorld Article
Challenging Cataract Cases: Better management of brunescent and dense white cataracts
by Vanessa Caceres EyeWorld Contributing WriterDense white cataracts and mature brunescent cataracts can make surgery particularly challenging, yet the reward comes once patients can see again. “Patients with bilateral brunescent cataracts are typically at hand motions and are the happiest of patients [after surgery]. They go from being unable to live alone to being able to drive,” said Zaina Al-Mohtaseb, MD....
Read more on EyeWorld.org >>
IC-113 Phaco Chop - Pearls & Pitfalls
Captured at the 2022 ASCRS Annual MEeting
Course Instructors: David F. Chang, MD, ABO, Barry S. Seibel, MD
This 2022 instructional course presents a stepwise game plan for converting to phaco chop, along with phacodynamic principles for selecting machine parameters and instrumentation. Attendees will don stereo glasses to view 3-D high-definition videos that uniquely illustrate the instrument positioning for both horizontal and vertical chopping. Pearls for brunescent nuclei and complicated cases will be covered.
ASCRS Clinical Committee Report
Phacoemulsification of the rock-hard dense nuclear cataract: Options and recommendations
By the ASCRS Cataract Clinical Committee and Challenging and Complex Cataract Surgery Subcommittee
We describe the essential steps in the successful phacoemulsification of the rock-hard, dense cataract. Appropriate and directed preoperative history, physical examination, and diagnostics allow the surgeon to select the best incision, anesthesia, and intended surgical technique for a given dense nuclear challenge. Hard nucleus-specific approaches for hydrodissection, pupil management, and zonular protection...
JCRS Article
Piggyback miLOOP-assisted phacoemulsification combined with intraocular lens scaffold in hypermature cataracts
Journal of Cataract & Refractive Surgery: November 2021Hypermature cataracts with liquified cortex pose a higher risk for capsular complications due to a distended capsular bag, floppy posterior capsule, and absence of any cushioning epinucleus. Disassembly of a brunescent nucleus is more difficult because of the thickened, leathery posterior plate...
Read more on the JCRS Website >>
JCRS Article
Phacoemulsification of the rock-hard dense nuclear cataract: Options and recommendations
Journal of Cataract & Refractive Surgery: July 2018We describe the essential steps in the successful phacoemulsification of the rock-hard, dense cataract. Appropriate and directed preoperative history, physical examination, and diagnostics allow the surgeon to select the best incision, anesthesia, and intended surgical technique for a given dense nuclear challenge...
Read more on the JCRS Website >>
Innovative Techniques and Technologies to Conquer Brunescent Cataracts: Video-Based Course
Course Instructors: Arup Bhaumik, MS, Debashis Dutta, MS, Mrinmoy Das, MBBS, Sanjib Banerjee, MBBS, and Suven Bhattacharjee, MD
Phacoemulsification of brunescent cataracts is challenging. Grading systems of cataracts probably cannot predict hardness, thickness, and leatheriness of these nuclei. This video-based course will highlight all types of techniques and newer technologies to conquer the hardest nuclei. Course will also highlight all probable complications management.
View this Instructional Course