Dense White Cataract Surgery Technique (Non-Intumescent)

You've seen the notation in the patient chart: "DWC" which stands for Dense White Cataract, but there is actually a spectrum of cataracts that appear to be white. And they are not all dense and they can behave very differently during surgery. There is a way to differentiate white cataracts during the pre-operative consultation so that you can determine how best to approach the surgery, which techniques to use, and what potential complications are possible.

The nuclear density can vary greatly, with some white cataracts being soft, milky, and intumescent in nature, while others can be hard and rock-like with a high degree of nuclear sclerosis. The differentiation between a dense white cataract and a soft white cataract is important in devising a surgical plan for phacoemulsification.

Dense white cataracts tend to be in older patients and on slit lamp examination there is a yellow to brown hue to the central portion of the crystalline lens. The anterior capsule tends to look relatively flat with no evidence of fluid within the capsular bag. Once the capsule is stained with trypan blue dye, the capsulorrhexis should be fairly routine with little risk of radialization. However, due to the density of the nucleus a larger degree of ultrasonic phaco energy will likely be required and the risk of corneal endothelial trauma or even phaco wound burn is higher. For these eyes, re-coating the endothelium with a dispersive viscoelastic during phaco and utilizing ultrasonic power modulations can help to lessen the risks.