Anterior segment optical coherence tomography for demonstrating posterior capsular rent in posterior polar cataract

Clinical Ophthalmology, Jan 2014

Anterior segment optical coherence tomography for demonstrating posterior capsular rent in posterior polar cataract George D Kymionis,1,2 Vasilios F Diakonis,1 Dimitrios A Liakopoulos,1 Konstantinos I Tsoulnaras,1 Nektarios E Klados,1 Ioannis G Pallikaris11Institute of Vision and Optics, Department of Medicine, University of Crete, Heraklion, Crete, Greece; 2Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida, USAAims/purpose: To report the preoperative use of anterior segment optical coherence tomography (AS-OCT) for the determination of pre-existing posterior capsule defect in patients with posterior polar cataract.Methods: Three patients presented with posterior polar cataract and were evaluated preoperatively using AS-OCT, revealing in one patient intact posterior capsule and in the other two a pre-existing posterior capsule defect not detectable by slit-lamp evaluation. All patients underwent phacoemulsification and intraocular lens implantation.Results: Intraoperatively, AS-OCT findings were confirmed after cataract surgery in all patients. No intra- or late postoperative complications were noted.Conclusion: AS-OCT could be an additional useful imaging modality in these patients, essential for surgical planning and patient consultation.Keywords: posterior capsular cataract, phacoemulsification, cataract complications, posterior capsular rupture, anterior segment optical coherence tomography

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://www.dovepress.com/getfile.php?fileID=18668

Anterior segment optical coherence tomography for demonstrating posterior capsular rent in posterior polar cataract

Clinical Ophthalmology anterior segment optical coherence tomography for demonstrating posterior capsular rent in posterior polar cataract George D Kymionis 0 1 Vasilios F Diakonis 1 Dimitrios a Liakopoulos 1 Konstantinos i Tsoulnaras 1 Nektarios e Klados 1 ioannis G Pallikaris 1 0 Bascom Palmer eye institute, University of Miami, Miller school of Medicine , Miami, Florida, Usa , USA 1 institute of Vision and Optics, Department of Medicine, University of Crete , Heraklion, Crete , Greece PowerdbyTCPDF(ww.tcpdf.org) Aims/purpose: To report the preoperative use of anterior segment optical coherence tomography (AS-OCT) for the determination of pre-existing posterior capsule defect in patients with posterior polar cataract. Methods: Three patients presented with posterior polar cataract and were evaluated preoperatively using AS-OCT, revealing in one patient intact posterior capsule and in the other two a pre-existing posterior capsule defect not detectable by slit-lamp evaluation. All patients underwent phacoemulsification and intraocular lens implantation. Results: Intraoperatively, AS-OCT findings were confirmed after cataract surgery in all patients. No intra- or late postoperative complications were noted. Conclusion: AS-OCT could be an additional useful imaging modality in these patients, essential for surgical planning and patient consultation. - Postoperatively, all patients demonstrated improvement in both uncorrected and corrected distance visual acuity (Table 1). Preoperative assessment Complete preoperative assessment was performed on all patients, along with AS-OCT with a specific area of interest, the posterior capsule, for the determination of PPC-related defect (Figures 1B and 2B). AS-OCT revealed in respect of case 1 an intact posterior capsule (Figure 1B), whereas cases 2 and 3 demonstrated an area of posterior capsule defect (Figure 2B). /:/sw rseo Cataract surgery tthp rop All patients were informed about the type of cataract and fredm F tahewrriitstkesn iinnvfoolrvmededincosnusrgeenrtyf;ofrutrhtheeirrmpoarreti,citphaetyiopnroivnidthede o ldoa study and for the surgical procedure, in accordance with onw the institutional guidelines and the Declaration of Helsinki. ygd Phacoemulsif ication was performed under peribulbar loo anesthesia. This was preferred in case of an unexpected ltahm intraoperative complication occurring. Hydrodelineation hpO and gentle viscodissection were performed in all cases. After liilcanC lwineeraetmioonv,ewdethpeaerntidaollnyucvliesucsodusisinsegcltoewd-(puresisnsugredihsypderrosdiveeviscoelastic) the peripheral epinucleus (by lifting the anterior capsule), avoiding the central part of the capsule (the area of the defect). We removed the epinucleus peripherally toward the center in order to leave a small portion of it at the area of possible defect, which was the last part that we removed. Intraoperatively, an intact posterior capsule was revealed in patient 1, whereas a posterior capsule defect was found in patients 2 and 3. Intraoperative findings confirmed the preoperative AS-OCT results. Anterior vitrectomy was performed in the patients with posterior capsule defect due to posterior capsule rupture extension. A three-piece intraocular lens was placed into the sulcus in these patients. No intra- or postoperative complications were noticed in the three cases, such as intraocular lens dislocation or development of cystoid macular edema. Discussion The aim of the surgical approach in cases with PPC is to minimize turbulence and pressure in the anterior chamber and the capsular bag, thereby preventing iatrogenic posterior capsule rupture or extension of a pre-existing posterior capsule defect.3–6 To achieve this, slow-motion phacoemulsification and gentle hydrodelineation along with gentle viscodissection or hydrodissection have been proposed.1,3 Furthermore, Vasavada and Raj7 propose a technique to achieve precise hydrodelineation, which they name “insideout delineation.” This approach eliminates the possibility of fluid being injected inadvertently into the subcapsular plane, leading to unwarranted hydrodissection, and leaving submit your manuscript | www.dovepress.com Dovepress 8 1 0 2 l u J 2 1 n o 7 1 1 . 2 2 . 8 3 . 4 5 y b / m o c . s rse l.y m F o fr d e d a o l n w o d y g o l o m l a h t h p O l a c i n li C Posterior capsular rent in posterior polar cataract the crystalline lens, demonstrating a discontinuation defect at the posterior capsule (yellow arrow) (images of case 2). an intact cortical shell, which prevents the extension of a in patients with PPC. Even though this is only a three-patient posterior capsular rent. series and final conclusions may not be drawn on the impact In our case studies, we utilized AS-OCT, an imagAS-OCT may have on the management of PPC, it seems ing modality that overcomes the drawbacks of slit-lamp that it is feasible to detect a discontinuation of the posterior examination. We were able to detect a posterior capsule capsule using this technology. rupture in cases 2 and 3, and an intact capsule in case 1. A possible limitation of this imaging technology could be Disclosure the inability of detection of a “true” capsular defect, as the No author has financial or proprietary interest in any product, optical density of the overlaying lens opacity could create method, or material used in this study. false positive outcomes. Nevertheless, in our cases, surgery confirmed the AS-OCT findings. All cases achieved satisfactory postoperative visual acuity. Iatrogenic posterior capsule rupture may also occur without its pre-existence. This mainly occurs due to the crystalline lens adhesions on the posterior capsule and the surgical maneuvering during cataract extraction. Nevertheless, posterior capsule pre-existing defects increase significantly the possibility of nucleus drop and the need for posterior segment interventions. Conclusion It seems that AS-OCT may be utilized as an additional modality for the identification of pre-existing capsule rupture Publish your work in this journal Clinical Ophthalmology is an international, peer-reviewed journal covering all subspecialties within ophthalmology. Key topics include: Optometry; Visual science; Pharmacology and drug therapy in eye diseases; Basic Sciences; Primary and Secondary eye care; Patient Safety and Quality of Care Improvements. This journal is indexed on PubMed Central and CAS, and is the official journal of The Society of Clinical Ophthalmology (SCO). The manuscript management system is completely online and includes a very quick and fair peer-review system, which is all easy to use. Visit http://www.dovepress.com/ testimonials.php to read real quotes from published authors. 1. Vasavada AR , Raj SM , Vasavada V , Shrivastav S. Surgical approaches to posterior polar cataract: a review . Eye . 2012 ; 26 : 761 - 770 . 2. Ghosh YK , Kirkby GR . Posterior polar cataract surgery: a posterior segment approach . Eye . 2008 ; 22 : 844 - 848 . 3. Singh K , Mittal V , Kaur H . Oval capsulorhexis for phacoemulsification in posterior cataract with preexisting posterior capsule rupture . J Cataract 4 . Fine IH , Packer M , Hoffman RS . Management of posterior polar cataract . 5. Siatiri H , Moghimi S . Posterior polar cataract: minimizing risk of posterior capsule rupture . Eye . 2006 ; 20 : 814 - 816 . 6. Hayashi K , Hayashi H , Nakao F , Hayashi F. Outcomes of surgery for posterior polar cataract . J Cataract Refract Surg . 2003 ; 29 : 45 - 49 . 7. Vasavada AR , Raj AM . Inside-out delineation . J Cataract Refract Surg . 2004 ; 30 ( 6 ): 1167 - 1169 .


This is a preview of a remote PDF: https://www.dovepress.com/getfile.php?fileID=18668

George D Kymionis, Vasilios F Diakonis, Dimitrios A Liakopoulos, Konstantinos I Tsoulnaras, Nektarios E Klados, Ioannis G Pallikaris. Anterior segment optical coherence tomography for demonstrating posterior capsular rent in posterior polar cataract, Clinical Ophthalmology, 2014, 215-217, DOI: 10.2147/OPTH.S55763