Elucidating intraoperative dynamics and safety in posterior polar cataract with intraoperative OCT-guided phacoemulsification.

PURPOSE: To evaluate morphological characteristics and intraoperative dynamics of posterior polar cataract (PPC) using intraoperative optical coherence tomography (iOCT). SETTING: Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. DESIGN: Prospective interventional study. METHODS: Forty eyes with PPC undergoing phacoemulsification were evaluated. Primary outcome measure was morphology of PPC and intraoperative dynamics of posterior capsule (PC). Secondary outcome measure was PC rent, which was retrospectively compared with 72 PPC cases that underwent non-iOCT-guided surgery. RESULTS: Of the 40 eyes evaluated, 3 morphological variants of PPC were observed: type I (19/40 [47.5%]) characterized by intact PC and clearance between PC and opacity, type II (12/40 [30%]) with intact PC in periphery of opacity, shadowing, and inability to detect PC in the center, and type III (9/40 [22.5%]) with dense opacity, extensive shadowing, and inability to delineate PC. In addition to hydrodelineation, hydrodissection was performed in all cases of type I PPC. In types II and III PPC, only hydrodelineation was performed. No case with type I opacity developed PC dehiscence. Three cases (7.5%) with types II (1 eye) and III (2 eyes) PPC developed PC dehiscence during aspiration of epinuclear cushion. Intraocular lens was implanted in all cases in the bag or sulcus. There was no significant difference in PC dehiscence between iOCT-guided and non-iOCT-guided surgery (P = .7). CONCLUSIONS: iOCT-guided surgery helps to elucidate intraoperative dynamics in PPC and assess real-time PC integrity. It characterizes high-risk morphological features, enables safe hydrodissection in a subset of PPC, but does not decrease the incidence of PC dehiscence.

Real-time intraoperative dynamics of white cataract-intraoperative optical coherence tomography-guided classification and management.

PURPOSE: To evaluate morphological characteristics and intraoperative dynamics of different types of white cataract using intraoperative optical coherence tomography (iOCT). SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. DESIGN: Prospective interventional study. METHODS: Fifty eyes with white cataract undergoing phacoemulsification were evaluated. The primary outcome measure was the classification of white cataract based on morphology and intraoperative dynamics on iOCT. The secondary outcome measure was rhexis-related complications. RESULTS: Four types of white cataract were identified based on iOCT-type I (9 eyes), type II (3 eyes), type III (24 eyes), and type IV (14 eyes). Type I had regularly arranged lamellar cortical fibers, type II had continuous hyperreflective bands of cortical fibers with intralenticular clefts, type III had intralenticular clefts combined with areas of homogenous ground-glass appearance, and type IV had homogenous ground-glass appearance of the anterior lens cortex. Capsulorhexis in type I cataract was uneventful. In type II cataract, cortical bulge was observed in the anterior chamber on creating the initial nick, indicating raised intralenticular pressure (ILP) with an imminent risk of rhexis extension. A bimanual irrigation/aspiration was performed until lowering of ILP was observed on iOCT. In types III and IV, fluid release was observed on initiation of rhexis leading to partial (type III) or complete (type IV) lowering of ILP, with a mild-moderate risk of capsulorhexis extension. A continuous curvilinear capsulorhexis was achieved in all cases, with no case of posterior capsular tear or vitreous loss. CONCLUSIONS: Intraoperative OCT helped elucidate intraoperative dynamics of the spectrum of white cataracts and facilitates completion of capsulorhexis.

Impact of Clear Corneal Incision Morphology on Incision-Site Descemet Membrane Detachment in Conventional and Femtosecond Laser-Assisted Phacoemulsification.

PURPOSE: To assess intraoperative morphology of clear corneal incisions (CCI) and its impact on incision-site descemet membrane detachment (DMD) in conventional phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS). METHODS: Prospective comparative study of 129 eyes that underwent either conventional phacoemulsification (Group I, n = 77) or FLACS (Group II, n = 52) was undertaken at an apex tertiary care ophthalmic setup. In group I, a 2.2-mm metal keratome was used to create a biplanar CCI. In group II, femtosecond laser-assisted biplanar CCI was created with 2.2 mm diameter. Incision architecture and incision-site DMD were assessed using microscope-integrated intraoperative OCT (iOCT) and anterior segment OCT on postoperative day (POD) 1 and 30. Visual acuity was assessed on POD 1 and 30. RESULTS: Smooth slit (SS) or ragged slit (RS) morphology of the proximal opening of CCI was observed immediately after creation [Group I: 68.8% SS, 31.2% RS; Group II: 86.5% SS, 13.5% RS]. DMD was observed in 87.1% cases with RS and 16.3% cases with SS morphology (p < 0.001). DMD was more frequent in group I (Group I = 38/77, Group II = 5/52; p < 0.001) and most commonly observed during the step of stromal hydration (83.7%). DMD was self-resolving and did not persist in any group at 1 month. Visual acuity was comparable in both groups on POD 1 and 30. CONCLUSION: Ragged morphology of proximal opening of CCI is the most important predictive factor for incision-site DMD. Femtosecond-laser CCIs have less incision-site DMD as compared to keratome-assisted CCIs. iOCT provides real-time assessment of CCI morphology and DMD.