Evaluation of Posterior Capsular Integrity using a Posterior Segment Optical Coherence Tomography (OCT) with a+20 Diopter Lens

Author(s): Puspa Kumari, Sarojini Murmu, Marianus Deepak Lakra

Aim: The objective of this study was to present the surgical and visual outcomes, as well as evaluate the risk factors associated with posterior capsular rupture in cases of posterior polar cataracts.

Methods: The objective of this study was to present the surgical and visual outcomes, as well as evaluate the risk factors associated with posterior capsular rupture in cases of posterior polar cataracts.

Results: The average age at which symptoms manifested was 47 years, with a majority of patients falling below the age of 50 years. The study population consisted of individuals ranging in age from 20 to 70 years. There was no observed sexual predilection in the overall population, with males comprising 48% and females comprising 52% of the sample. The prevailing symptom observed among the younger age group of patients was the presence of glare and challenges associated with night driving. Among a cohort of 100 patients, it was observed that Posterior polar cataract exhibited comorbidity with Posterior subcapsular cataract in 4% of cases. Additionally, 23% of cases showed an association with nuclear sclerosis, while 2% of cases were found to have pre-existing posterior capsular dehiscence. In our study, 41% of the cases were treated with small incision cataract surgery, while the remaining 59% of patients underwent phacoemulsification. The most prevalent intraoperative complication observed was posterior capsular rupture, which accounted for approximately 8% of the cases. This phenomenon can be ascribed to the altered surgical methodology and heightened cognizance of the vulnerable posterior capsule. A prevalence of 4% was observed in cases where residual posterior capsular plaque was detected. To address this, Nd- Yag capsulotomy was performed as a postoperative management strategy. The postoperative visual acuity demonstrated a significant improvement in comparison to the baseline visual acuity (p-value < 0.001), with the exception of one case that exhibited no change due to the presence of marked amblyopia.

Conclusion: Although the management of posterior polar cataract presents a formidable challenge even for seasoned surgeons, selecting a closed chamber surgical approach, attaining a well-executed capsulorhexis, implementing specific modified surgical techniques that minimise strain on the zonules and posterior capsule, meticulously removing the central epinuclear shell as the final step of cortical clean up, abstaining from nucleus rotation, and performing posterior capsule polishing can lead to a favourable surgical outcome.