Role of anterior segment optical coherence tomography for safer management of mature white cataracts

Role of anterior segment optical coherence tomography (AS-OCT) for safer management of mature white cataracts.

Patients with mature white cataracts attending the outpatient department of a tertiary eye care hospital, aspiring to have cataract surgery performed, were scheduled for elective phacoemulsification and intraocular lens implantation by two surgeons during the period of October 2017 to March 2018.

A prospective interventional study of 30 patients.

All patients with mature cataracts and absence of any retinal pathology had AS-OCT to assess the presence or absence of intralenticular subcapsular fluid pockets. The patients with the presence of subcapsular fluid pockets (Group 1) underwent 30-gauge needle aspiration fluid aspiration followed by capsulorhexis and phacoemulsification and those without any fluid (Group 2) underwent Utrata forceps-assisted capsulorhexis.

The study comprised 30 eyes of 30 patients, of which 15 eyes (50%) had subcapsular fluid and 15 eyes (50%) had no fluid on AS-OCT. Of the 15 eyes in Group 1, 13 eyes (86.7%) underwent complete circular curvilinear capsulorhexis (P = .001), with a surgical success rate of 87%, whereas 2 eyes (13.3%) had capsular runaway complications. Of the 15 eyes with no subcapsular fluid, 13 eyes (86.7%) underwent complete circular curvilinear capsulorhexis (P = .001), whereas 2 eyes (13.3%) had posterior capsule rupture. Thus, 87% of the cases had uneventful capsular outcomes in each group.

The detection of subcapsular fluid on AS-OCT allows better planning and management with 30-gauge assisted-needle drainage of fluid, thus decreasing the chances for capsular runaway complications with better surgical outcomes.