ASCRS Focus on Cataract Surgery | ASCRS
ASCRS Clinical Education

ASCRS Focus on Cataract Surgery

Surgical Management of Hard Cataracts

September 2020

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.

In this month's Focus on Cataract Surgery, explore a variety of video and print resources on the surgical management of hard cataracts in order to minimize your chance of surgical complications.

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

EyeWorld Article

Challenging Cataract Cases: Better management of brunescent and dense white cataracts

by Vanessa Caceres EyeWorld Contributing Writer
Dense 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 >>

EyeWorld Article

Presentation spotlight: Breaking down the nucleus

by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer
Fresh advice from a seasoned surgeon can help keep surgeons on their toes. Speaking on nucleus management issues at the 22nd ESCRS Winter Meeting, Richard Packard, MD, Windsor, U.K., offered tactical pearls on how to use a variety of phacoemulsification approaches for nuclei of different densities....

Read more on EyeWorld.org >>

ASCRS Webinar: Phacodynamics of the Rock Hard Cataract

Moderator: Gary L. Foster, MD
Panelists: Kendall Donaldson, MD, Michael E. Snyder, MD, and Jonathan Solomon, MD

Sponsored by the Cataract Clinical Committee
This webinar will cover phacodynamics, techniques, and OVDs for the rock hard cataract, including machine specifics and femto laser-assisted considerations.

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...

Download Clinical Report

JCRS Articles

Explore the latest published research on posterior capsule rupture from ASCRS's premiere publication, the Journal of Cataract and Refractive Surgery.


Phacoemulsification of the rock-hard dense nuclear cataract: Options and recommendations (Jul 2018)
Journal of Cataract & Refractive Surgery: July 2018 - Volume 44 - Issue 7 - p 905-916
doi: 10.1016/j.jcrs.2018.03.038

"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 then allow the surgeon to approach the rock-hard nucleus with maximum safety..."

Read more on the JCRS Website
Retrochop technique for rock-hard cataracts (Jun 2013)
Journal of Cataract & Refractive Surgery: June 2013 - Volume 39 - Issue 6 - p 826-829
doi: 10.1016/j.jcrs.2013.03.015

"We describe a recently developed chopper, the retrochopper, and a technique for managing black and brunescent cataracts. The technique enables the surgeon to effectively disassemble the nucleus and perform a safe procedure with a short learning curve."

Read more on the JCRS Website
Phaco forward-chop technique for managing posterior nuclear plate of hard cataract (Jan 2010)
Journal of Cataract & Refractive Surgery: January 2010 - Volume 36 - Issue 1 - p 9-12
doi: 10.1016/j.jcrs.2009.07.047

Surgical management of hard cataracts can be problematic despite improvements in phacoemulsification devices. Phaco chop, considered one of the best techniques for dealing with hard cataracts, cannot always divide the hard cataract completely. We have devised a phaco forward-chop technique that can be implemented safely and efficiently following incomplete phaco chop in a hard cataract.

Read more on the JCRS Website
Microincision versus small-incision coaxial cataract surgery using different power modes for hard nuclear cataract (Oct 2011)
Journal of Cataract & Refractive Surgery: October 2011 - Volume 37 - Issue 10 - p 1799-1805
doi: 10.1016/j.jcrs.2011.04.024

Purpose: To compare the efficacy of microincision and small-incision coaxial phacoemulsification in treating hard cataracts using different ultrasound power modes.

Read more on the JCRS Website
Comparison of phaco-chop, divide-and-conquer, and stop-and-chop phaco techniques in microincision coaxial cataract surgery (Oct 2013)
Journal of Cataract & Refractive Surgery: October 2013 - Volume 39 - Issue 10 - p 1463-1469
doi: 10.1016/j.jcrs.2013.04.033

Purpose: To compare the outcomes of coaxial microincision cataract surgery (MICS) performed with 3 phacoemulsification techniques (phaco-chop, divide-and-conquer, and stop-and-chop) according to cataract density.

Read more on the JCRS Website

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