Managing the posterior polar cataract: An update

Vasavada, Abhay R.; Vasavada, Vaishali

doi:10.4103/ijo.ijo_707_17

Cited by 30 publications

(32 citation statements)

References 67 publications

(110 reference statements)

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“…The management of PPC is at times a difficult task even in the hands of most experienced anterior segment surgeons as [1,2] the incidence of intraoperative PC dehiscence have been noted to be around 36% [3][4][5][6]. Various means to identify a reliable method for PPC cases have been studied in literature with different machines, so that eyes at high risk versus low risk for PCR could be identified preoperatively but a definite method is still lacking in literature with a 100% specificity [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…Posterior polar cataracts (PPCs) have an abnormal adhesion of the posterior capsule leading to a polar opacity with or without a preexisting weakness of the posterior capsule (PC) [1]. It is a form of congenital cataract with an prevalence of 3 to 5 in 1000 [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…Even with newer techniques and better fluidic maintenance in cataract surgery, operating on PPC poses a challenge, as the reported incidence of posterior capsule rupture (PCR) in PPC ranges from 7.1% to 36% [5]. PCR can be noted intraoperatively during the various steps hydro-dissection, central nuclear emulsification, or spontaneously with sudden alterations in intraocular pressure (IOP) during insertion or removal of phaco hand piece [1]. As slit-lamp evaluations cannot accurately detect a preexisting PC dehiscence in PPC, therefore it's an apt knowledge on the integrity of PC preoperatively can provide an insight for improving surgical outcomes.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

In Preoperative Assessment of Posterior Polar Cataract

Dhami¹,

Dhami²,

Dhami³

2020

Act Sci Oph

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Objective: Preoperative anterior segment optical coherence tomography in assessing posterior polar capsule integrity. Method: A prospective observational study of 40 eyes of 25 patients. Patients with posterior polar cataracts undergoing elective cataract surgery were planned for ASOCT [Copernicus Revo (OCT NX700 Optopol technology) and the IOL master 700 (Carl Zeiss Meditec AG, Jena, Germany)] for determining the posterior capsular integrity and planned for phacoemulsification, by two surgeons during the period of January 2019 to December 2019. Posterior polar cataracts were categorized: Type 1-"continuous"; Type 2: abrupt, Type 3: "dehiscent". Results: A total of 40 eyes (25 patients) were included. 30 eyes (75%) were bilateral (15 patients) and 10 eyes (25%) were unilateral patients. ASOCT findings noted were, type-1 PPC were observed to be 85% (34 eyes) and 70% (30 eyes) equally detected with both the IOL master 700 and the Optopol ASOCT, Type-2 PPC were 12.5% (5) and 15% (6) of the cases and type-3 PPC were 2.5% (1) with the IOL master 700 and 10% (4) with the Optopol Revo ASOCT. The sensitivity and specificity for the IOL master 700 for predicting the PPC integrity was 90.32% and 66.27% each, and for the Optopol REVO ASOCT was 96.77% and 90% each. Intraoperatively, posterior capsular rent was noted in type-3 PPC, 2 cases (5%). Conclusion: AS-OCT provides a relevant insight for predicting preoperative PC deficits thus enabling better surgical planning and in anticipating PCR.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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In Preoperative Assessment of Posterior Polar Cataract

Dhami¹,

Dhami²,

Dhami³

2020

Act Sci Oph

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“…Epinuclear removal might be the most dangerous and difficult part of PPC surgeries [ 15 ]. Some surgeons use a phaco tip with very low aspiration flow rate, vacuum, ultrasound power, and bottle height, to strip the epinucleus from the PC [ 5 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Phacoemulsification with hydrodelineation and OVD-assisted hydrodissection in posterior polar cataract

Hua

Dong²,

et al. 2018

BMC Ophthalmol

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BackgroundTo evaluate the results and complications of phacoemulsification with hydrodelineation and ophthalmic viscosurgical device (OVD)-assisted hydrodissection for posterior polar cataract (PPC).MethodsMedical records of 24 eyes from 17 patients with clinical diagnosis of PPC, who underwent phacoemulsification with hydrodelineation and OVD-assisted hydrodissection, were retrospectively reviewed.ResultsThe incidence of posterior capsule rupture (PCR) was 16.67% (4/24): 2 cases occurred during epinucleus removal, and 2 cases occurred during OVD removal after the implantation of the intraocular lens into the bag. No nucleus piece or lens materials dropped into the vitreous during cataract surgery, and no obvious postoperative complications were found during follow-up. All patients had improved best-corrected visual acuity (BCVA) 1 month postoperatively.ConclusionOVD-assisted hydrodissection could be an effective technique in phacoemulsification to reduce the incidence of PCR and achieve satisfactory postoperative outcomes.

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“…Due to its inherent capsular weakness and/or dehiscence, the risk of capsular tear and subsequent complications are not uncommon. [ 1 2 3 4 ] Beginning from continuous curvilinear capsulorrhexis to phacoemulsification to wound closure, every surgical step needs well-planned execution. [ 1 2 5 ] The hydrodissection procedure in routine cataract surgery is meant to separate the peripheral lens plate from the capsule, and the hydrodelineation procedure is meant to create separation between the nucleus and the epinucleus.…”

mentioning

confidence: 99%

Study 3

Pujari

Sharma

Bafna

et al. 2021

Indian Journal of Ophthalmology

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Purpose: To describe the changes along nucleo-epinuclear and the opacity-capsular junction during hydrodelineation and the entire period of phacoemulsification using intraoperative optical coherence tomography (iOCT). Methods: A total of 12 eyes of 12 patients with clinically confirmed posterior polar cataract, who underwent cataract surgery by a single surgeon under the direct guidance of iOCT. The changes along nucleo-epinuclear junction and opacity-capsular junction during/following hydrodelineation and the changes along the opacity-capsular junction following nucleus removal, capsular changes before the opacity removal, and its dynamic changes throughout the surgical procedure were studied. Results: The mean age of patients was 48.25 ± 7.89 years. Eight of them were males and the right eye was operated in seven patients. With regular hydrodelineation, optimal separation of the nucleus-epinuclear layer was evident in 11 patients. Once a golden ring is achieved through the hydro procedure, then repeated attempts can be performed within it to decrease the chances of capsular damage. Fracture of the posterior opacity with tension over the underlying capsule ( n = 1), inadvertent hydro dissection while performing hydrodelineation ( n = 1), continuous posterior capsular billowing ( n = 2), and posterior capsular ruptures ( n = 2) were encountered in this observation with even well-judged surgical maneuvering. Conclusion: iOCT provides a better understanding of real-time changes along different layers of the human lens during posterior polar cataract surgery. The observations obtained here are likely to help in minimizing inadvertent complications in the future.

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Managing the posterior polar cataract: An update

Cited by 30 publications

References 67 publications

In Preoperative Assessment of Posterior Polar Cataract

In Preoperative Assessment of Posterior Polar Cataract

Phacoemulsification with hydrodelineation and OVD-assisted hydrodissection in posterior polar cataract

Study 3

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