Trypan blue-assisted modified closed circular capsulorhexis in white cataracts: A prospective study of intraoperative and postoperative complications and visual outcome

A prospective study was conducted on 46 eyes of 46 patients having white cataracts, who underwent manual small incision cataract surgery and were followed up on the 1st, 7th, and 30th postoperative days. Intraoperative and postoperative complications were noted, and postoperative visual outcomes were assessed. Of 46 patients with white cataracts, mature cataract constitutes 30 (65.4%) patients, hypermature cataracts – 8 (17.3%) patients, and intumescent cataracts – 8 (17.3%) patients. The most common intraoperative complications were extension of continuous curvilinear capsulorhexis (CCC) (30.4%), Argentinian flag sign (4.34%), hyphema (4.34%), iris prolapse (4.34%), posterior capsular rupture, and vitreous loss (2.17%). The most common postoperative complications were corneal edema (36.9%), striate keratopathy (34.7%), residual cortex (13.04%), and rise in intraocular pressure (6.52%). Visual outcome on day 30 showed vision >6/9 in 67.3%, 6/12–6/9 in 17.3%, and 6/60–6/18 in 6.5%. Patients having a poor vision had moderate nonproliferative diabetic retinopathy (NPDR) with diabetic macular edema in 6.5%, age-related macular degeneration – 4.2%, severe NPDR – 2.1%, and optic atrophy – 2.1%.We conclude that modified techniques such as use of trypan blue, high-density ophthalmic viscosurgical device, mini-rhexis (two-staged CCC), and aspiration of cortical fluid using a 26G needle during CCC can decrease ocular morbidity and achieve a good postoperative visual outcome.