Studies have shown that 1 out of 3 posterior polar cataract surgeries result in a ruptured posterior capsule. Here’s the technique to avoid that complication:
Posterior polar cataracts are congenital opacities at the posterior pole of the crystalline lens. These types of posterior lens opacities can progress over the years and become more visually significant, leading to a decline in visual acuity and necessitating cataract surgery.
Phacoemulsification of a posterior polar cataract is particularly challenging because the posterior capsule can be weak, fragile or even absent at the site of the opacity. This leads to a higher risk of posterior capsule rupture, vitreous loss and other complications. Initial studies have demonstrated that this risk is as high as one in three patients, although recent reports peg the risk a bit lower. The size of the posterior polar opacity may also influence the risk of capsular rupture, with larger opacities associated with greater risk.
Multiple surgical techniques and approaches have been described, but the one common goal is to avoid manipulation of the posterior capsule at the site of the posterior polar opacity. The technique that I prefer is hydrodelineation to remove the central lens endonucleus, followed by viscodissection of the remaining lens epinucleus and cortex. Generally, you should avoid hydro-dissection in all cases of posterior polar cataracts.
Dr Lalit Singhal from India has an alternate approach and it works well in his hands. He uses the chopper to mechanically separate the endo-nucleus from the rest of the cataract and to separate the epi-nuclear shell from the lens capsule.
Click below to see a comparison of 2 approaches for posterior polar cataracts:
Wow, do you happen to know how Dr. Singhal is holding his instruments? I haven’t really seen that degree of separation between the para and main wounds. Great video and discussion!