Rock-hard cataracts pose various challenges for surgeon

Although advanced nuclear sclerotic cataracts are seen with less frequency within the average U.S. practice, the rock-hard cataract does occasionally present in our examining lane and on the operating table. These dense lenses can be some of our most difficult cases due to numerous intrinsic challenges including poor visibility, fibrotic or fragile anterior capsules, large lens size, adherent cortical capsular connections, a thin or deficient epinucleus, and tenacious leathery lens fibers. Special considerations should allow the surgeon to approach these advanced cataracts with more confidence and decrease the incidence of serious intraoperative complications.