This is a patient with a history of high hyperopia (+7.5 of hyperopia) and posterior polar cataracts since childhood. The posterior polar opacities have worsened over the past few years and she is becoming less tolerant of her contact lenses. She has dry eye syndrome which has worsened now that she is 45 years old and living in the dry, warm Los Angeles area exacerbates the condition due to the low ambient humidity levels. Her surgery will be challenging due to the posterior polar cataracts, the short axial length, and the shallow anterior chamber.
Because the lens nucleus is relatively soft, we have elected to just use the irrigation / aspiration (I/A) probe to remove the entire cataract. This will allow us more control and few exchanges of instrumentation during the procedure. A critical step in a posterior polar cataract surgery is making a round, 5 mm capsulorhexis so that if the capsule ruptures we can securely place a three-piece IOL with the haptics in the sulcus and the optic captured behind the capsulorhexis.
We were unable to fully remove the posterior polar opacity during the primary cataract surgery. This is perfectly fine and we will plan for a YAG laser posterior capsulotomy after about 3 months of healing. This patient did very well with surgery and with the +28.5 D IOL, we were able to correct all of her hyperopia and give her an emmetropic outcome. She is incredibly happy even before doing the YAG capsulotomy, and we will schedule her second eye soon.
Click below to see Soft Posterior Polar Cataract Surgery with just the I/A probe:
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