The surgical challenges dense brunescent cataracts present

Dense brunescent cataracts represent a major challenge for surgeons. We performed a literature review focusing on surgical challenges dense brunescent cataracts present. All relevant literature was included in order to describe anatomical landmarks, risk factors, preoperative preparation, surgical techniques (wound creation and burn, capsulorhexis, hydrodissection and hydrodelineation, endothelium protection, phaco-chop techniques), challenges and complications that dense brunescent cataracts surgery present. At the end, we present a speculative viewpoint on how the field will evolve in 5 years. We conclude that with a good preoperative evaluation, surgical planning, advanced protective viscoelastic, modern phacoemulsification machine with optimized parameters and high-quality chop techniques, phacoemulsification assisted or not with femtosecond laser pretreatment can be performed in most of dense brunescent cataracts surgical cases without complications. Knowledge of extracapsular cataract extraction, anterior vitrectomy and keratoplasty techniques is important for surgeons facing these cases because complications can occur.