Phacoemulsification in eyes with posterior polar cataract

To evaluate the results of phacoemulsification in eyes with posterior polar developmental cataract and to appraise the strategy for surgical management.

Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India.

This prospective study comprised 25 consecutive patients. All surgeries were performed by 1 surgeon. Endophacoemulsification was carried out after hydrodelineation. Hydrodissection or rotation was not attempted. A 2-port vitrectomy was performed when necessary.

Mean follow-up was 13.72 months (range 7 to 22 months). Nine patients (36%) developed posterior capsule rupture and 8 (32%) revealed plaques. An intraocular lens (IOL) was implanted in all 25 eyes. In 8 of 9 cases with rupture, the haptics were placed in the sulcus; in 1 case, the IOL was placed in the bag. One patient in the capsular rupture group developed macular edema 3 weeks postoperatively that responded to conservative treatment. Among 25 patients, 18 had a visual acuity of 20/20 to 20/30 and 6, 20/80 to 20/120. These 6 patients had residual posterior capsule plaque. All except 2 patients with plaque required a neodymium:YAG capsulotomy. In these patients, visual acuity improved to 20/30. In 1 patient, with microcornea, acuity did not improve to beyond 20/120.

This study confirms the predisposition to posterior capsule rupture in eyes with posterior polar cataracts. Careful surgical planning produces satisfactory technical and visual outcomes.