Bimanual decompression of intumescent cataract - Safety and refractive outcomes

Intumescent white cataracts are challenging because of the high risk of intraoperative complications and poor outcomes. Several techniques have been proposed to mitigate altered lenticular dynamics; however, they require surgical expertise or additional costly devices. Here, we report the safety and outcomes of a recently described bimanual decompression technique. We retrospectively reviewed consecutive cases of intumescent cataract between January 2020 and July 2023. We assessed the rates of intraoperative complications, post-op refractive outcomes, and deviations from predicted values. Fifty-nine patients (mean age, 63 years) underwent this procedure. All the patients underwent planned monofocal single-piece intraocular lens (IOL) without intraoperative complications. The preoperative visual acuity was 20/200 or worse in all patients. Postoperatively, 92% of the patients achieved a visual acuity of 20/60 or better. Predicted refraction accuracy within 0.5 diopters was achieved in 56% of patients, and 90% were within 1 diopters. Automated bimanual decompression is a simple, safe, and cost-effective method for managing intumescent cataracts. This method provides a practical solution to the challenges associated with capsulorhexis formation in these complex cases.