Preexisting posterior capsule defect progressing to white mature cataract

Raj

et al. 2012

Eye

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.

Section: Surgical Approach In Eyes With a Spontaneous Dislocationmentioning

confidence: 99%

Surgical approaches to posterior polar cataract: a review

Raj

et al. 2012

Eye

“…Meanwhile, because PCD disrupts the barrier between the lens and the aqueous and vitreous humors, the exposed cortex might lead to a change in the intraocular inflammatory environment, which in turn might cause the dynamic progression of PCD. Moreover, PCD seems to be the cause of progressive mature cataract in children, as reported by Vasavada et al (6). However, no study to date has definitively demonstrated the mechanism underlying PCD and related cataract.…”

Section: Discussionmentioning

confidence: 86%

“…Our previous study showed that the percentage of PCD in eyes with congenital cataract was as high as 26.7% (5). The presence of PCD is probably the cause of progressive mature cataract in children, but the underlying mechanism remains unknown (6).…”

Section: Introductionmentioning

confidence: 98%

Characteristic cytokine profile of the aqueous humor in eyes with congenital cataract and pre-existing posterior capsule dysfunction

Zhao,

Zhang

et al. 2024

Front. Med.

ObjectivesTo investigate the characteristic cytokine profile of the aqueous humor in eyes with congenital cataract and pre-existing posterior capsule dysfunction (PCD).MethodsIn this cross-sectional study, the enrolled eyes with congenital cataract and PCD were included in the PCD group, while those with an intact posterior capsule were included in the control group. Demographic data and biometric parameters were recorded. The levels of 17 inflammatory factors in the aqueous humor collected from the enrolled eyes were detected using Luminex xMAP technology, and intergroup differences in the collected data were analyzed.ResultsThe PCD group comprised 41 eyes from 31 patients with congenital cataract and PCD, whereas the control group comprised 42 eyes from 27 patients with congenital cataract and an intact posterior capsule. Lens thickness was significantly thinner in the PCD group than in the control group. However, the levels of monocyte chemoattractant protein-1 (MCP-1), transforming growth factor-β2 (TGF-β2), and vascular endothelial growth factor (VEGF) were significantly higher in the PCD group than in the control group. Multivariate logistic regression confirmed that lens thickness and TGF-β2 level were independent risk factors for PCD.ConclusionA thinner lens thickness in eyes with congenital cataract and PCD could serve as a biometric feature of these eyes. The higher levels of MCP-1, TGF-β2, and VEGF in eyes with PCD indicated a change in their intraocular inflammatory microenvironment, which possibly led to cataract progression. Lens thickness and TGF-β2 level are independent risk factors for PCD.

“…[ 66 ] The preoperative diagnostic signs of a preexisting posterior capsule defect in children include a well-demarcated defect with thick margins, chalky white spots in a cluster or a rough circle on the posterior capsule, and white dots in the anterior vitreous that move with the degenerated vitreous such as a fishtail sign. [ 66 67 68 69 70 ] The surgical paradigms for cataract surgery in the eyes of children with PPC remain essentially similar to those used in adult eyes. [ 66 ] In eyes with PPC, an improvement in visual acuity (20/40 or better) has been noted in 84% of children after surgery.…”

Section: Posterior Polar Cataract In Childrenmentioning

confidence: 99%

Managing the posterior polar cataract: An update

2017

Indian J Ophthalmol

Posterior polar cataracts (PPC) have always been a challenge for cataract surgeons due to their inherently higher propensity for posterior capsule rupture. Over the years, several technical modifications have been suggested to enhance safety and reduce posterior capsule rupture rates in these polar cataracts. This review article tries to present the various techniques and strategies to published in literature to manage PPCs. It also discusses pearls for making surgery more reproducible and consistent, as well as the role of newer diagnostic and surgical technology based on the published literature on the subject.