Posterior Polar Cataract: Expert Level with Small Pupil, Floppy Iris, Dense Lens

Yesterday’s video showed the technique of using Visco-Dissection to aid in surgery for posterior polar cataracts. That patient had a relatively soft nucleus and great dilation. Today’s video is also a posterior polar cataract cases, but now at expert level since the patient also has a small pupil, floppy iris syndrome from Flomax use, and a dense crystalline lens.

Again, we avoid doing hydro-dissection since we do not want to put any pressure on the posterior capsule lest is rupture at the site of the polar opacity. We perform hydro-delineation but we’re unable to bring the endo-nucleus out of the capsular bag. To assist in this, the chopper is used to create a cleavage plane between the endo-nucleus and epi-nucleus. At this point the chopper is used to dial the endo-nucleus up into the anterior chamber at the iris plane. A generous aliquot of dispersive viscoelastic is used to create a barrier behind the nucleus and to re-coat the corneal endothelium.

Using phaco power modulations such as burst mode with a low duty cycle, a minimal amount of ultrasonic energy is used to remove the nucleus. The chopper aids in disassembly of the nucleus into small chunks. The case goes well and the patient ends up with an excellent visual outcome.

Watch the case and compare / contrast it to yesterday’s video of the softer posterior polar cataract.



  1. sir, Is an inside out hydrodelineation safer in case of a more dense endo nucleus with a posterior polar cataract? I tried one eye 3 days back using the bowl technique for endo nucleus and visco dissection for the rest of epinucleus as I could not get a delineation. Completed phaco with a lot of difficulty. Posterior capsule was intact. I am taking up second eye of the same patient with a similar PPC with grade 3 endonucleus . please give your suggestions.

    1. check out all of the posterior polar videos here on CataractCoach and then decide which approach will work best for your particular patient.

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