Posterior polar cataract: minimizing risk of posterior capsule rupture

Siatiri, H; Moghimi, Sasan

doi:10.1038/sj.eye.6702023

Cited by 28 publications

(32 citation statements)

References 11 publications

(30 reference statements)

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“…[1][2][3][4][5][6][7]9 The strategy basically involves maintaining the integrity of the polar opacity and the epinuclear plate until the nucleus has been emulsified. Emphasis has been placed on reduced bottle height, lowered vacuum and ultrasonic power, viscodissection of the outer nuclear plate, and avoiding overinflation of the capsular bag and AC.…”

Section: Discussionmentioning

confidence: 99%

“…The recommended strategy involves delaying removal of the polar opacity within the epinuclear plate until the conclusion of the procedure, combined with reduced machine parameters. [1][2][3][4][5][6][7] While the strategy is effective for tackling the soft posterior polar cataract, no phacoemulsification technique can effectively handle the hard posterior polar cataract (Lens Opacification Classification System III grades 4, 5, and 6). 8 I describe a technique that uses a manual method of cleaving a plane within the nucleus and creating an outer nuclear shell, allowing the nucleus to be safely removed.…”

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confidence: 99%

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Management of the hard posterior polar cataract

Chee

2007

Journal of Cataract and Refractive Surgery

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I describe a technique for managing the posterior polar cataract with a dense nucleus by initially sculpting a central trough to the depth of the polar opacity. The nucleus is partially cracked in the periphery, avoiding the polar opacity, and then chopped into quadrants without rotating. Next, the phaco tip engages the core of the nuclear quadrant while a cleavage plane is manually dissected along the lenticular lamellae using a Nagahara phaco chopper, with the tip rotated slightly so it points somewhat toward the equator of the lens, to a depth estimated to leave a nuclear shell, sparing the polar cataract. The nucleus is peeled away from the outer nucleus shell, which is kept in place by the phaco chopper. The intact nuclear plate is removed last and any capsular defect managed accordingly. This technique minimizes the risk for losing a nuclear fragment into the vitreous cavity.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Management of the hard posterior polar cataract

Chee

2007

Journal of Cataract and Refractive Surgery

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“…Using viscodissection instead of hydrodissection may protect the posterior capsule at the beginning of the surgery (9)(10)(11) . In our study, we used the viscodissection technique in the group 1 patients, which involved the injection of a dispersive viscoelastic material into the capsule to separate the lens from the capsule and make it freely mobile.…”

Section: Discussionmentioning

confidence: 99%

Phacoemulsification in posterior polar cataract

Çetinkaya¹,

Cetinkaya²,

Dadacı³

et al. 2016

Arquivos Brasileiros De Oftalmologia

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Approved by the following research ethics committee: Selcuk University Faculty of Medicine (#2014/206). ABSTRACTPurpose: To evaluate the results and complications of phacoemulsification surgery in eyes with posterior polar cataracts and compare the techniques of vis codissection and hydrodissection. Methods: The medical records of 29 consecutive patients (16 males, 13 females) with posterior polar cataracts (44 eyes) who had undergone cataract surgery were retrospectively reviewed. Patients were divided into two groups according to the technique used; viscodissection was applied to the experimental group (group 1) and hydrodissection to the control group (group 2). Results: The postoperative best corrected visual acuity (BCVA) was 0.19 ± 0.22 logMAR (mean ± standard deviation) (range 0.00-0.70) in group 1 and 0.25 ± 0.18 logMAR (range 0.00-0.70) in group 2. Although the mean postoperative BCVA in group 1 was greater than that in group 2, the difference was not statistically significant (p=0.165). The mean postoperative BCVA was significantly greater than the mean preoperative BCVA in both groups (p=0.00). Intraoperatively, posterior capsular rupture occurred during the removal of the cortex in three eyes (13%) of group 1 patients, with vitreous loss and anterior vitrectomy in one eye only. In group 2, six eyes (28.5%) presented posterior capsular rupture, and anterior vitrectomy was performed because of vitreous loss in three eyes. Although the percentage of posterior capsular rupture was greater in group 2, the difference was not statistically significant (p=0.207). Conclusions: Complications in posterior polar cataract surgeries can be overcome by being careful throughout the surgery and using proper techniques. Viscodissection may be better for avoiding posterior capsular rupture than hydrodissection.

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“…Co-existing anomalies have not been reported in literature, except for a report of retinitis pigmentosa in eyes with PPC in the Siatri and Moghini study. 5 Nada et al 6 reported two children under 3 years of age with unilateral Wilm's tumor having sporadic aniridia along with PPC. …”

Section: Co-existing Ocular Associationmentioning

confidence: 99%

Surgical approaches to posterior polar cataract: a review

Vasavada

Raj

Vasavada

et al. 2012

Eye

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The aim of this study is to provide a comprehensive overview of surgical methods used in the emulsification of posterior polar cataracts (PPCs) that have been devised to minimize the risk of posterior capsule rupture (PCR) and its consequences. A Pubmed and Medline search of relevant literature on PPC was done. Only articles relevant to the treatment of PPC were included. The posterior capsule in eyes with PPC are known to have an abnormal adhesion to the polar opacity or a pre-existing weakness of the capsule that predisposes the eye to PCR. To circumvent the consequences of cleaving the abnormal adhesion, a majority of the surgeons use the anterior approach through the limbus, whereas some advocate the posterior approach through the pars plana. Emulsifying the nucleus and cleaving the central opacity of the PPC off the posterior capsule without disrupting its integrity provides optimal surgical outcomes. To achieve this, various modifications have been applied by surgeons during different phases of surgery. The advantages, disadvantages, complications, and results of each method have been discussed. Phacoemulsification is the preferred technique for removing PPC. This review will provide methods to avoid and /or deal with intraocular surgical difficulties that can arise during emulsification. Employing these would result in least ocular morbidity and satisfactory visual outcomes for the patient. This is particularly relevant given the major advancements in technology and refinements in surgical techniques in phacoemulsification.

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Posterior polar cataract: minimizing risk of posterior capsule rupture

Cited by 28 publications

References 11 publications

Management of the hard posterior polar cataract

Management of the hard posterior polar cataract

Phacoemulsification in posterior polar cataract

Surgical approaches to posterior polar cataract: a review

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