Abstract

Mature intumescent cataracts always pose difficulty in surgery even in experienced surgeon's hand. There is always a chance of rhexis runout, Argentinian flag sign, posterior capsular tear in these cases which may lead to less than desirable end result. Phacoemulsification in these cases can be done with caution and with proper expertise: but better avoided in case of beginner surgeons. The safer alternative is to go for Manual Small Incision Cataract Surgery (MSICS) in these cases. Here we have demonstrated a MSICS in mature white intumescent cataract. Though rhexis poses a challenge in these cases, but with proper use of viscoelastics and careful manoeuvre of instruments in chamber taking care not to decompress the chamber, a continuous curvilinear circular rhexis could be managed in this case. Nucleus delivered out using a fishhook made out of 26G needle. Rest of the steps have been enumerated and illustrated in the video.