1739: peeling a posterior polar plaque

We all know that posterior polar cataracts are challenging because at the site of the polar opacity the capsule can be weak, fragile, or even frankly absent. Studies from Vasavada and Osher have demonstrated that about one third of these cases may result in posterior capsule rupture and related complications. The key step is to perform only hydro-delineation while avoiding hydro-dissection. Once the cataract is removed, this patient is left with a small central opacity. The question is, Do you attempt to remove this with the IA probe or do you just plan a YAG laser capsulotomy in the near future? What is your choice?

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  1. You could inject a dispersive viscoelastic close to the plaque to peel it off from the posterior capsule.

    1. Do you think that will be less risky than just trying to lift it off with polish mode of the I&A? I personally would just let well enough be and yag it at a later date.

  2. It depends on the tyoe of polar cataract, we use oct to determine the extent of the posterior polar cataract. If it is grade 2 or 3 we leave it alone and yag it laterr or do a posterior ccc. When it is a grade 1 we usually try to peel/polish it off very gently with a I/A silicon handpiece and with low I/A parameters
    Thank you for your daily work to teach Us how to be better surgeons

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