Identification Of Cases That Presented Greater Difficulty For The Surgeon In Performing Capsulorrhexis During Cataract Surgeries With Intraocular Lens Implantation.

To identify the cases that presented greater difficulty for the surgeon in performing capsulorrhexis (CCC) during cataract surgeries with intraocular lens implantation.

The CCC is a critical step during modern cataract surgery and some cases may impose greater difficulty to the surgeon during CCC, increasing the risks of complications during the surgery. This is a retrospective study, evaluating medical records of 12,459 cataract surgeries performed between 2005 and 2025 in an ophthalmological medical center in Brazil.

Through a retrospective study, evaluating medical records of 12,459 cataract surgeries performed between 2005 and 2025, the cases that presented greater difficulty for the surgeon in performing CCC during cataract surgeries with intraocular lens implantation were identified. A scale of 0 to 10 was used to assess difficulty during CCC and a score above 8 was considered as very difficult.

The cases that offered the greatest difficulty for the surgeon during CCC, with a difficulty score above 8, were (in number of surgeries): intraoperative floppy iris syndrome (IFIS) with small pupil (102 surgeries), intumescent white cataracts (93), corneal opacities (54), traumatic cataracts (18), Parkinson's disease with head movement (9), Alport syndrome with anterior lenticonus (4), Marfan syndrome with lens subluxation (4), aniridia (2), microspherophakia (2) and keratoglobus (1).

In this study, the 3 most frequent causes of difficulty during CCC were IFIS with small pupil, intumescent white cataracts and corneal opacities, followed by several other less frequent causes. Recognizing these causes of greater difficulty during CCC is relevant so that the surgeon can be adequately prepared for surgery, in order to reduce surgical risks.