Study 1: Evaluation of the signs of deficient posterior capsule in posterior polar cataracts using anterior segment optical coherence tomography

Abstract

Purpose: To systematically observe and analyze the signs of deficient posterior capsule in posterior polar cataracts. Design: Ambispective observational study. Participants: Cases with posterior polar cataracts. Methods: Eyes with diagnosed posterior polar cataracts were imaged on anterior segment optical coherence tomography (AS-OCT). A detailed assessment was performed to note the morphology of the posterior opacity, posterior capsule, and the common patterns to indicate their abnormality. In addition, generalized observation of the morphology was also performed about intraoperative surgical experiences. Results: A total of 101 eyes were included. Mean patient age was 52.85 ± 10.72 years. The posterior capsule integrity was identified as intact in 91 eyes and abnormal/deficient in 10 eyes (9 had intraoperative defective capsule). These deficient/abnormal morphologies were classified into 3 categories: conical (n = 2), moth-eaten (n = 5), and (3) ectatic (n = 3). Similarly, depending on the presence of hypoechoic spaces between the opacity and the capsule, remaining posterior polar cataracts were categorized into 2 generalized morphological types: without hypoechoic areas (n = 40) and with hypoechoic areas (n = 51). In the without hypoechoic areas group, 6 cases developed capsular rent; in the with hypoechoic areas group, 1 case developed capsular rent. Conclusions: In posterior polar cataracts, the deficient/abnormal capsular morphology could be specifically categorized into 3 categories, conical, moth-eaten, and ectatic types. In addition, to predict the ease of intraoperative separation between the opacity and the capsule, generalized categorization might help in better case management.

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

“… 17 Recently, in Pujari's report, abnormal/deficient PC was identified in 10 eyes (9.9%) in a total of 101 adult eyes. 19 The possible reasons for the lower PCR rate in pediatric patients might be as follows. First, the PC of pediatric patients was more resilient than that of the adults.…”

The Emerging Role of Anterior Segment Optical Coherence Tomography in Cataract Surgery: Current Role and Future Perspectives

“…Again, here, in the presence of anterior dense opacity, posterior capsular details are very well appreciated before surgery. 1 Hence, the newer SS-ASOCTs are able to provide better images from anterior cornea to the posterior capsule in a single frame. In addition, these images can be magnified up to 200 times, with enhanced finer details up to micrometres, and with minimally degraded image quality.…”

“…In addition, these images can be magnified up to 200 times, with enhanced finer details up to micrometres, and with minimally degraded image quality. 1 To summarize, the ASOCT-related considerations in PPCs to decipher the posterior capsule as intact or dehiscent are growing. In this direction, the more deeply penetrating ASOCTs (such as SS-ASOCT) are able to provide better information.…”

“…Anterior segment optical coherence tomography (ASOCT) provides crosssectional details of ocular tissues from the corneal surface to the anterior hyaloid face (Figure 1, Video 1). 1 Using this sophisticated technology, we are able to image the tissue details in micrometres with good clinical reproducibility. 1 The advantages of ASOCT in measuring corneal and anterior chamber angles have often been highlighted in the literature; however, the use of ASOCT in cataract surgery is new, and hence understanding its critical role in the management of lens-related diseases is of paramount importance.…”

“…1 Using this sophisticated technology, we are able to image the tissue details in micrometres with good clinical reproducibility. 1 The advantages of ASOCT in measuring corneal and anterior chamber angles have often been highlighted in the literature; however, the use of ASOCT in cataract surgery is new, and hence understanding its critical role in the management of lens-related diseases is of paramount importance. To our knowledge, there have been no dedicated reviews compiling the ASOCT-derived information for cataract surgeons.…”