Elucidating intraoperative dynamics and safety in posterior polar cataract with intraoperative OCT-guided phacoemulsification

Abstract

Purpose: To evaluate morphological characteristics and intraoperative dynamics of posterior polar cataract (PPC) using intraoperative optical coherence tomography (iOCT). Setting: Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. Design: Prospective interventional study. Methods: Forty eyes with PPC undergoing phacoemulsification were evaluated. Primary outcome measure was morphology of PPC and intraoperative dynamics of posterior capsule (PC). Secondary outcome measure was PC rent, which was retrospectively compared with 72 PPC cases that underwent non–iOCT-guided surgery. Results: Of the 40 eyes evaluated, 3 morphological variants of PPC were observed: type I (19/40 [47.5%]) characterized by intact PC and clearance between PC and opacity, type II (12/40 [30%]) with intact PC in periphery of opacity, shadowing, and inability to detect PC in the center, and type III (9/40 [22.5%]) with dense opacity, extensive shadowing, and inability to delineate PC. In addition to hydrodelineation, hydrodissection was performed in all cases of type I PPC. In types II and III PPC, only hydrodelineation was performed. No case with type I opacity developed PC dehiscence. Three cases (7.5%) with types II (1 eye) and III (2 eyes) PPC developed PC dehiscence during aspiration of epinuclear cushion. Intraocular lens was implanted in all cases in the bag or sulcus. There was no significant difference in PC dehiscence between iOCT-guided and non–iOCT-guided surgery (P = .7). Conclusions: iOCT-guided surgery helps to elucidate intraoperative dynamics in PPC and assess real-time PC integrity. It characterizes high-risk morphological features, enables safe hydrodissection in a subset of PPC, but does not decrease the incidence of PC dehiscence.

Intraoperative OCT for the assessment of posterior capsular integrity in pediatric cataract surgery

“… 19 Recently, Titiyal et al used iOCT to assess real-time PC integrity of posterior polar cataracts and proved that it characterized high-risk morphological features, which were consistent with the deficient morphology detected by AS-OCT in their previous report. 15 …”

“…[12][13][14] Titiyal et al reported the intraoperative dynamics and safety in posterior polar cataract with iOCT-guided cataract surgery in adult patients. 15 However, to our knowledge, no study has assessed the PC during surgery in pediatric patients with posterior lens opacity. In this article, we evaluated the role of iOCT in understanding the integrity of the PC in pediatric cataracts with posterior lens opacity.…”

Clinical applications for intraoperative optical coherence tomography: a systematic review

“…In 2016, Amir-Asgari et al assessed the effect of swirling/pinballing lens fragments in the anterior chamber and the endothelial damage that these fragments can cause, finding that smaller particles with higher velocity tend to inflict more damage than larger, slower moving particles [112]. Titiyal et al used the iOCT to investigate morphological characteristics and dynamics of white cataracts and posterior polar cataracts [113,114]. Distinct characteristics of white cataract that were observed on OCT in different degrees included; the convexity of the anterior capsule, arrangement and reflectance of cortical fibers, presence of clefts, and homogenous ground glass appearance [114].…”

“…Distinct characteristics of white cataract that were observed on OCT in different degrees included; the convexity of the anterior capsule, arrangement and reflectance of cortical fibers, presence of clefts, and homogenous ground glass appearance [114]. In posterior polar cataract they identified differences in delineating of the posterior capsule, reflectivity of the posterior polar opacity and underlying capsule, and adherence of the opacity to the posterior capsule [113]. Based on these features the authors propose new classification systems for these types of cataract, thereby aiding patient care and future research.…”

Evolution of optical coherence tomography: from the laboratory to the operating room

“…Titiyal et al in a prospective study evaluated the morphological characteristics of posterior polar cataracts using iOCT and were able to demonstrate 3 morphological variations that had implications on the intraoperative surgical maneuvers performed. 16 In this issue, Chen et al (page 261) for the first time demonstrate the use of iOCT during pediatric cataract surgery. They were able to morphologically characterize pediatric posterior polar cataracts and differentiate between posterior lenticonus and posterior polar cataracts.…”