Evaluation of a Modified Single-Stage Continuous Curvilinear Capsulorhexis Technique Using 18-Gauge Needle Decompression in Intumescent Cataracts

To evaluate the safety and efficacy of a modified anterior capsulorhexis technique using an 18-gauge needle puncture at the peripheral one-third of the anterior capsule to control intralenticular pressure and achieve single-stage continuous curvilinear capsulorhexis (CCC) in intumescent cataract surgery. This prospective, cross-sectional descriptive study included patients with intumescent cataracts indicated for surgery at Saigon Vinh Eye Hospital from August 2024 to March 2025. Before CCC, all patients underwent an 18-gauge needle puncture at the peripheral one-third of the anterior capsule near the main incision. A total of 99 eyes from 99 patients were included in the study. The mean axial length was 23.12 ± 0.55 mm, anterior chamber depth 2.62 ± 0.43 mm, and lens thickness 4.91 ± 0.72 mm. In 65 patients (65.7%), the milky liquefied cortex escaped into the anterior chamber after the needle puncture. Single-stage CCC was successfully performed in 98 of 99 cases (98.9%) with a mean capsulorhexis diameter of 5.5 ± 0.3 mm. All surgeries were performed using standard phacoemulsification and in-the-bag IOL implantation (100%). Three months post-operatively, all patients had well-centered IOLs with a best-corrected visual acuity (BCVA) ≥ 4/10. An 18-gauge needle puncture at the peripheral one-third of the anterior capsule offers effective decompression, improves safety, and facilitates CCC in patients with intumescent cataracts. This technique is simple, feasible, and highly applicable in clinical practice.