This case caught me by surprise: in the pre-operative notes this was listed as a posterior sub-capsular cataract, but when I had the patient under the surgical microscope with the enhanced retro-illumination image, it was clearly posterior polar.
We have covered the issues and techniques for posterior polar cataracts many times here, here, and here. And we have even had a guest surgeon show his technique. The primary consideration in eyes with posterior polar cataracts is that the risk of capsule rupture is much higher because at the site of the polar opacity the capsule is fragile, weak, or even absent.
The keys to successful posterior polar cataract surgery include:
- do not perform hydro-dissection, which could blow out the posterior capsule
- hydro-delineation is fine and visco-dissection with a dispersive agent can work quite well
- do not touch the posterior capsule or attempt to vacuum it
- do not let the anterior chamber collapse as this could also lead to capsule rupture
- it is better to do a YAG laser capsulotomy later than risk a ruptured capsule
The posterior polar cataract is present, typically in a milder form, for the patient’s entire life. This patient who is now in her 60s was told as a young adult that she had some form of cataract. With time the central opacity becomes cloudier and elements of a posterior sub-capsular cataract start to develop, the patients tend to seek cataract surgery.
Click below to see how we successfully completed this posterior polar cataract case: