Posterior Polar with capsule defect seen on AS-OCT
A posterior polar cataract is a known surgical landmine, but in this case, we have the ultimate “heads-up”: the Anterior Segment OCT (AS-OCT) clearly shows a pre-existing defect in the posterior capsule. There is no guesswork here—the bag is already compromised before we even make the incision.
Despite the most delicate hydrodelineation (remember: never hydrodissect a polar!), the inevitable happens: the posterior capsule splits wide open during nucleus rotation. This video is a masterclass in staying calm when the “expected complication” finally arrives.
The Salvage Protocol:
- Avoid the “Gush”: The moment the split occurs, do not pull the phaco tip out. Maintain infusion to keep the chamber pressurized and prevent the vitreous from rushing forward.
- Viscodissection: Use a highly dispersive OVD to create a barrier between the lens material and the vitreous face.
- Slow Motion Surgery: We transitioned to low-flow fluidics and used a “slow-motion” phaco technique to remove the remaining fragments without enlarging the PC tear.
- The Final Result: Watch how we managed to perform a limited anterior vitrectomy and still achieved stable sulcus IOL placement with optic capture.
When the OCT warns you of a “hole in the bucket,” you better have your OVD and your backup plan ready!
