Morphological variations influencing the outcomes in posterior polar cataract

To study the intraoperative complications and postoperative clinical outcomes in different types of posterior polar cataract (PPC) following phacoemulsification, based on morphological classification.

All consecutive patients with PPC who underwent phacoemulsification during the study period from 2016 to 2019 were included and sub-grouped based on the morphological characteristics according to Daljit Singh's classification. Intraoperative complications such as posterior capsular rupture (PCR), vitreous loss, nucleus drop, and Postoperative best-corrected visual acuity (BCVA) at day 1 and day 30 were documented.

A total of 388 eyes of 380 patients were included. Eighty nine (22.9%) eyes belonged to type 1, 135 (34.8%) belonged to type 2, 8 (2.1%) belonged to type 3, and 156 (40.2%) belonged to type 4. Thirty-five (9.3%) eyes had intraoperative PCR, with vitreous loss in 21 (60%) eyes, and nucleus/cortex drop in 5 (1.3%) eyes. Six (75%) eyes of type 3, 14 (10.04%) eyes of type 2, 12 (17.7%) eyes of type 4, and 3 (3.4%) eyes of type 1 PPC had PCR. PCR occurred more during the emulsification of the nucleus (18 cases, 51.4%). A significant correlation was seen between intraoperative PCR and type of PPC with a higher incidence in type 3 (P < 0.001). BCVA was found to be significantly worse on day 1 among patients with PCR compared to those who did not and improved well by day 30.

PPC morphology is significantly co-related with the occurrence of PCR, emphasizing the need for careful grading of posterior polar cataracts in predicting the risk of intraoperative complications.