AAO 2019 Video Program
    Cataract/Anterior Segment

    We describe intraoperative OCT (iOCT)-guided management of intumescent white cataract. Two types of intumescent white cataracts were observed on iOCT. Type A had swollen hyper-reflective stromal fibers beneath the anterior capsule, with multiple intralenticular clefts in underlying cortex. On initiation of capsulorrhexis, a cortical bulge was visualized in the anterior chamber through the capsular opening without any fluid release, with an imminent risk of capsulorrhexis extension. An iOCT-guided bimanual aspiration of cortex was performed until intralenticular pressure (ILP) decreased and the cortical bulge recessed. Type B cataract had large hyporeflective vacuoles beneath the anterior capsule. Spontaneous slow release of turbid fluid was observed on initiation of capsulorrhexis with decrease of ILP. iOCT aids in creation of an adequate-sized capsulorrhexis in all cases with raised ILP without any capsular tears/extension. Phacoemulsification was uneventful in all cases.