We have covered the topic of posterior polar cataracts many times before and we even have an entire section on CataractCoach devoted to the topic. The key message is that at the site of the posterior polar opacity the capsule is weak, fragile, or even partially absent. In published studies by Osher and Vasavada the rate of posterior capsule rupture is very high, as much as 1 out of 3 patients. We can help lessen this risk by avoiding hydro-dissection and I would also avoid using a femtosecond laser since this can increase the intra-lenticular pressure as gas bubbles are formed. I have described the technique of visco-dissection which works very well to help separate the cortex and epi-nucleus from the posterior capsule. Before doing this we need to remove the endo-nucleus which I do in this case by using the chopper to lift it up. But wait, not so fast, there ends up being an issue with the capsule… watch this complete cataract case (shown start to finish) to see what happens and how I manage to give a great result.
