Assessment of posterior capsule integrity in posterior polar cataracts using anterior segment OCT
Mudaliar Ashwini Elango1, Arokiam John Bosco2, S Thanikachalam2
1Senior Resident, Department of Ophthalmology, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry, India.
Background:
Posterior polar cataracts (PPC) pose a great surgical challenge to ophthalmic surgeons. Main intraoperative surgical concerns are increased risk of posterior capsular rupture (PCR), vitreous loss, and nuclear drop. Traditional assessment of posterior capsule integrity utilizing anterior segment- optical coherence tomography (AS-OCT) requires training, and it is a time-consuming process. Recent techniques of posterior capsule assessment need additional software installation, raising the cost of investigation for the patient. This video demonstrates a time-saving method to assess posterior capsular integrity using regular AS-OCT, which can be learnt and practiced easily in outpatient department (OPD).
Purpose:
Ultrasound and 20 D lens mounted on posterior segment optical coherence tomography (OCT) are some of the popular methods to assess the posterior capsule. Such techniques need training and are laborious. Our technique used to assess posterior capsule integrity in PPC using AS-OCT is simple, time saving, and can be easily practiced.
Synopsis:
The technique described requires AS-OCT lens to be mounted on the lens aperture. The console panel is set to scan on scleral mode. AS-OCT is advanced to capture the cornea, anterior capsule, and posterior capsule. Intact posterior capsule is visualized as a continuous well-defined hyper-reflective layer, and any break in the continuity of this hyper-reflective layer suggests posterior capsule dehiscence, which can further be studied based on literature classifications.
Highlights:
(1) Importance of proper preoperative assessment in cases of PPC. (2) Detailed technique of using anterior segment OCT module in acquiring scans of posterior capsule in PPC. (3) How to find whether the posterior capsule is intact versus dehiscent. (4) Clinical cases showing utility of this technique. (5) Uses and benefits.
Video Link:
https://youtu.be/AohMG4jT13M.
