SURGICAL TECHNIQUES FOR THE MANAGEMENT OF BRUNESCENT CATARACTS AND THEIR OUTCOMES
Published 2026 - 30th ESCRS Winter Meeting
Reference: CC06 | Type: Case Report | DOI: 10.82333/r466-eq49
Authors: Dmytro Zhaboiedov* 1 , Mykola Dovbysh 2 , Ivo Ďurkovič 2
1The Department of Ophthalmology of Bogomolets National Medical University,Bogomolets National Medical University,Kyiv,Ukraine;Ophthalmology,iClinic plus s.r.o.,Bratislava,Slovakia, 2Ophthalmology,iClinic plus s.r.o.,Bratislava,Slovakia
Purpose
To compare different surgical approaches for the removal of dense brunescent cataracts and to evaluate their safety, efficiency, and postoperative outcomes.
Setting
The study was conducted at iClinic s.r.o., Ophthalmology Clinic, Bratislava, Slovakia — a tertiary referral center specializing in cataract and refractive surgery. All procedures were performed by the same surgeon under standardized operative conditions between January 2025 and October 2025.
Report of case
A prospective analysis of 20 cases of advanced brunescent cataracts was performed. Three phacoemulsification techniques were evaluated and compared: pre-chop, stop-and-chop, and anterior chamber phacoemulsification with lens nucleus disassembly performed within the anterior chamber.
For each technique, the following parameters were analyzed: effective phacoemulsification time (EPT), total ultrasound energy, intraoperative complication rate, corneal edema, and postoperative best-corrected visual acuity (BCVA). Additionally, the study assessed the risk of intraoperative zonular stress and posterior capsule rupture.
Successful extraction of the opacified crystalline lens with in-the-bag intraocular lens (IOL) implantation was achieved in all cases. The anterior chamber phacoemulsification technique provided better control in cases with extremely dense nuclei but was associated with a slightly higher rate of early postoperative corneal edema.
The pre-chop technique demonstrated the lowest cumulative dissipated energy (CDE) and the shortest ultrasound time. The overall complication rate was low, and no cases of lens luxation into the vitreous cavity were observed. Postoperative visual recovery was good across all groups.
Conclusion / Take home message
The selection of an optimal nucleus fragmentation technique and appropriate energy settings is crucial for the safe and effective management of brunescent cataracts. The pre-chop and stop-and-chop techniques offer an optimal balance of efficiency and safety, reducing intraoperative stress and minimizing postoperative complications.