Posterior Polar Cataract Management: My Approach E Video Book

 Posterior Polar Cataract Management:My Approach

Dr Sudhir Singh, MS

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 Introduction

Posterior polar cataracts (PPC) are cataracts lying on the posterior pole of the lens. They are stuck to the posterior capsule, so there are many times more chances of the post capsule ruptures and related sequelae. In this E Video book, I am going to share my approach.

Pre-operative considerations and plans

1.     Patient Counseling: Patient counseling is very important and it requires substantial chair time with a patient and relative to explain the complexities of the disease, procedure, and chances of re-surgeries in writing.

2.     Anesthesia and Akinesia: My preferred choice is peribulbar local anesthesia with good akinesia.

3.     Capsulorhexis Size: I prefer moderate size central capsulorhexis

4.     Hydro Procedures: I prefer hydro delineation and gentle hydro dissection. Many surgeons do not advise doing hydro dissection. I found the hydro-dissection in the posterior capsular cataracts very useful as it separates the epinucleus from the posterior capsule in the most natural way. The hydro delineation in posterior cataracts is also very beneficial as it separates the nucleus from the epinucleus. Fine et al.40 used minimal hydro dissection and hydro delineation, nuclear emulsification from within the epinuclear shell, and gentle viscodissection of the epinucleus and cortex to avoid unnecessary pressure on the posterior capsule and to protect the region of the greatest potential weakness throughout the procedure⁴. 

5.     Intraocular Lens: If the posterior capsule remains intact then any hydrophobic lens if I have planned phacoemulsification. Poly methyl methacrylate (PMMA) intraocular lens for manual small incision cataract surgery (MSICS) and posterior capsule rupture with intact anterior capsulorhexis. In the case of the medium, large posterior capsule rent (PCR) and the sulcus, my preferred lens is PMMA IOL.

6.     Always keep your vitrectomy machine on standby

Management