Different faces of the white cataract: A phaco surgeon's perspective

Purpose: To develop a system of categorizing white cataracts so that the salient features, as would be pertinent to phacoemulsification surgery, could be recognized pre-operatively. Methods: Patients with total cataracts were carefully evaluated using slit-lamp biomicroscopy and slit-lamp photography. An attempt was made to determine whether pre-operative evaluation could ascertain the presence or absence of features of these cataracts that often cause surgical difficulties, namely, increased intralenticular pressure (ILP), milky cortex and brown nuclear colour. Results: Using a standardized method of biomicroscopic evaluation, it was found that the status of the ILP, cortex and nuclear colour could be determined consistently. Surgical strategies based on such a system of categorization has permitted white cataracts to be consistently managed using phacoemulsification. Conclusions: Systematic pre-operative evaluation and categorization of white cataracts based on the ILP, status of the cortex and nuclear colour can permit proper surgical planning and successful management of such cases with phacoemulsification.