Technique for PSC Cataract Surgery in younger patients

Posterior SubCapsular (PSC) cataracts are more commonly found in our younger patients and in particular, they can cause difficulty with glare from oncoming light sources such as the setting sun or opposing traffic headlights while driving. These PSC cataracts can progress quickly and their symptoms tend to be more obvious in these younger patients. It is important that we achieve excellent results when performing cataract surgery for these patients since they will look through our surgery for the next 40 or 50 years.

The primary issues for doing PSC cataract surgery in a younger (approximately 50 years old) patient are:

• The lens capsule is more elastic and capsulorhexis creation can be challenging. Due to the elasticity, creating a 4.5 mm capsulorhexis may end up expanding to a 5.0 mm size. Also, the direction of tearing forces tend to be pulling a bit inward to prevent radialization.
• The lens material is soft and a traditional technique like phaco chop, stop-and-chop, or divide-and-conquer will not work well. The best technique is to prolapse the soft nucleus out of the capsular bag using hydro-dissection and hydro-delineation.
• These patients may still have some accommodation, so we need to prepare them for the new vision with the IOL. In this case, a monofocal IOL is being placed since the patient wishes to maximize vision for driving at night. While multifocal IOLs can give some degree of near and far vision, these patients may not be pleased with the night vision compromises.
• Younger patients may be more likely to get posterior capsule opacification in the first year after cataract surgery and a YAG laser capsulotomy may be needed to clear the visual axis to restore sharp vision.

Click below to learn my technique for Posterior SubCapsular cataract surgery: