EyeRounds Online Atlas of Ophthalmology
Contributor:
William Charles Caccamise Sr,MD, Retired Clinical Asst Prof of Ophthal. U.of Rochester School of Medicine & Dentistry
Category: Neuro-ophthalmology
Diagnosis: bilateral intumescent cataract
Image Comments:
In the era prior to Kelman's introduction of phacoemulsification and a return to extracapsular cataract surgery, great emphasis was placed on the differential diagnosis of the various stages of cataract. It was an unpleasant day for the surgeon when a planned intracapsular procedure turned into an inadvertent extracapsular cataract extraction. During Dr. Caccamise's experience at the Kurji Holy Family Hospital Eye Clinic (1951 through 1968 with 15 to 20 cataract operations daily except on Sunday ) an emphasis was placed on intracapsular cataract surgery - using either the Smith-Indian technique or the Bell microerisiphake. It was found that the intumescent cataract was the most difficult so-called senile cataract to remove wihout rupturing the capsule - next was the classic hypermature Morgagnian cataract ( " a bag filled with milk containing a loose dark brown nucleus " ), followed by the cataracta nigra, and then the immature corticonuclear/posterior subcapsular cataract.With subsequent photographs the hypermature Morgagnian cataract will be presented and discussed in greater detail. Notice the details of this female's left cataract. There are sectorial markings that are pathognomonic in differentiatng the intumescent cataract from the classic swollen hypermature Morgagnian cataract ( in some later photograph, there will be a discussion of the extremely rare shrunken hypermature cataract - an entirely different and more formidable matter). The intumescent cataract represents a potential stage between the immature cortical/corticonuclear cataract and the mature corticonuclear cataract. There is a sudden - sometimes within a few days - dramatic change in the previously immature cortical cataract so that the intumescent cataract appears as in this patient. This is not to be confused with cataracta complicata ( a photograph will be presented at a later date )which has a similar appearance and demonstrates a similar fragility of the anterior capsule during attempted intracapsular surgery. The present use of " white cataract " as a blanket term for the various stages of cataract that a " white pupil " may represent leaves much to be desired. It should be emphasized that the intumescent stage is rarely part of the usual historical development of cataracts that the surgeon will face in surgery.
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