Approaches to a posterior polar cataract

Posterior polar cataracts present special challenges to the cataract surgeon. These are often associated with weakness/dehiscence of the posterior capsule and thus have a higher rate of intraoperative posterior capsule rupture. The surgeon needs to adhere to special surgical strategies to minimize the risk of a posterior capsule rupture. These include, adhering to the principles of closed chamber technique, avoiding hydrodissection - instead performing 'inside-out' hydrodelineation and using modest to low phaco parameters and reducing these stepwise. This article provides important pearls on how to approach a posterior polar cataract

Approaches to a posterior polar cataract inside-out delineation and strategies for emulsification

Management of a posterior polar cataract poses a special challenge to the cataract surgeon because of its predisposition to posterior capsule dehiscence during surgery. The following principles help guide the surgeon during the procedure. Preoperatively the patient has to be counseled thoroughly regarding the possibility of drop nucleus. A thorough preoperative evaluation is mandatory to look for an associated posterior capsule defect. The surgical technique should include the following steps: Maintain a closed chamber at all times, perform an adequate-sized anterior capsulorhexis, avoid hydrodissection - instead perform Inside-Out Hydrodelinearion, during nucleus emulsification use low fluid parameters and follow the principles of slow motion technique and step down technique. Inject OVD before removing any instrument from the eye. In case of a posterior capsule dehiscence, try to convert the dehiscence into a posterior capsulorhexis. Inject Viscoat over the area of dehiscence and perform adequate 2-port automated anterior vitrectomy. In case of a posterior capsule dehiscence implant IOL in the bag only if a complete posterior capsulorhexis is achieved