Surgical approaches to posterior polar cataract: a review

Abstract

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.

Application of 25 MHz B-Scan Ultrasonography to Determine the Integrity of the Posterior Capsule in Posterior Polar Cataract

“…Additionally, it is very difficult to evaluate the integrity of the PC before a cataract surgery because the plaque obstructs examination by all optical instruments that are normally used to measure the relationship between the PPC and PC. In the first type of PPC, the PC itself is intact, while in the second, the PC has a preexisting dehiscence [ 4 , 5 ]. It is almost impossible to distinguish between the two types in clinical examinations performed using currently available instruments.…”

“…Vasavada et al [ 5 ] suggested that increasing our understanding abnormalities that are observed in the PC could decrease the incidence of PCR. The risk of PCR during phacoemulsification has decreased from 36% to 6-7% [ 1 , 2 , 13 , 15 , 17 ], a change that is partially explained by the success of different surgical techniques or modifications to them [ 7 , 18 ], such as performing hydrodelineation only in cases without hydrodissection, viscodissection without nuclear rotation, inside-out delineation, slow-motion phacoemulsification, and layer-by-layer lens removal [ 19 , 20 ].…”

“…Posterior polar cataract (PPC) is one of the most challenging types of cataract, and it has a high risk of intraoperative posterior capsule rupture (PCR) or even nuclear or cortical drop [ 1 – 4 ]. In addition, the diagnosis of these conditions depends mainly on clinical observations made under slit lamp biomicroscopy, and the following three clinical categories are based on these clinical presentations: PPC with intact posterior capsule (PC), PPC with preexisting PC dehiscence, and spontaneous dislocation [ 5 , 6 ]. The risk of PCR is higher during cataract surgery for PPC partially as a result of the tight adherence of the posterior polar opacity and the reduced integrity of the thin PC [ 7 – 9 ].…”

Phacoemulsification in posterior polar cataract

“…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.…”

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

“…Posterior polar cataract (PPC) is a type of developmental cataract characterized by a white, well-defined, distinctive discoid opacity located on or in front of the central posterior capsule (PC) [ 1 ]. PPC presents a special challenge to the phaco surgeon due to its high risk of posterior capsule rupture (PCR), vitreous loss, and even nuclear drop during cataract surgery, which can occur because of extreme weakness, pre-existing dehiscence or tight adherence of opacity in the PC [ 2 ].…”