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Slit Lamp / Anterior Segment Dx · Mature (intumescent) white cataract, left eye

Mature white cataract — slit-lamp view before MICS phacoemulsification

Dense white cataract with no red reflex — a surgical planning case for capsular staining and iris hooks.

Patient context — 68-year-old male, gradual painless loss of vision left eye × 12 months

Submitted byDr. Manisha Mishra

Diffuse-illumination slit-lamp photograph of a 68-year-old farmer from Ballia district referred with 'complete loss of vision, left eye' over the past year. The lens is uniformly white, intumescent, and there is no red reflex on retro-illumination.

Because the anterior capsule cannot be visualised through the opaque lens, we routinely use trypan blue capsule staining and a dispersive OVD (Viscoat) during capsulorhexis. B-scan ultrasound was done pre-op to rule out a posterior segment pathology.

Post-op day 1 vision: 6/9 uncorrected, with a monofocal aspheric IOL implanted in the bag.

Surgical pearls:

  • Always confirm PL/PR and a normal B-scan before proceeding with a white cataract.
  • Trypan blue converts a blind surgery into a controlled one.
  • Consider a two-stage capsulorhexis if intra-lenticular pressure is high.

Further reading & references

Medical disclaimer

This article is for patient education. It is not a substitute for personalised medical advice, examination or diagnosis. If you have symptoms discussed here, please book an in-person consultation with a qualified ophthalmologist.