Anterior segment optical coherence tomography for demonstrating posterior capsular rent in posterior polar cataract
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
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
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
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.
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
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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
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
It seems that AS-OCT may be utilized as an additional
modality for the identification of pre-existing capsule rupture
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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 .