Phacoemulsification in Posterior Polar Cataract: Experience From a Tertiary Care Center in North India
Purpose
To describe the surgical technique, and to determine the rate of posterior capsular rupture and post operative outcomes in patients of posterior polar cataract undergoing phacoemulsification at a tertiary care centre in North India.
Methods
This was a prospective study including 80 eyes of 64 consecutive patients presenting with posterior polar cataract. All surgeries were performed by single surgeon . Phacoemulsification was carried out after controlled hydrodelineation to separate the endonucleus from the epinuclear shell and cortex, making V or lamda shaped nucleo fractis with the phaco tip followed by multiple chopping of the nucleus ensuring the integrity of the epinuclear part of the lens, which acted as a protective cushion. The anterior chamber was not allowed to shallow at any point of time with dispersive OVD always being injected prior to withdrawing the phacotip.
Results
Thirty-four (42.5%) eyes had grade 2, 20 (25%) eyes grade 3 and 26 (32.5%) eyes grade 4 cataract. Six (7.5%) eyes developed posterior capsular rupture. Posterior chamber intraocular lenses (PCIOLs) were successfully implanted in 98.7% of cases with only one eye (1.3%) being left aphakic. The implanted IOL's included single piece hydrophobic acrylic in 36 (45%) eyes, three piece hydrophobic acrylic in 38 (47.5%) eyes and rigid PMMA IOLs in 5 (6.3%) eyes. Mean best corrected logMAR visual acuity improved from 0.667 ± 0.517 log MAR units preoperatively to 0.11 ± 0.201 log MAR units at 3 months postoperatively.
Conclusion
Phacoemulsification in posterior polar cataract can have excellent postoperative outcomes, and low rates of posterior capsular rupture with the technique of controlled hydrodelineation, making of a lambda or v shaped nucleofractis for removal of the first fragment, and preventing sudden shallowing of the anterior chamber at all steps.