Application of anterior segment optical coherence tomography to identify eyes with posterior polar cataract at high risk for posterior capsule rupture

Abstract

To use anterior segment optical coherence tomography (AS-OCT) to identify eyes with posterior polar cataract at high risk for posterior capsule rupture (PCR) during cataract extraction. Hong Kong Eye Hospital, Hong Kong, China. Retrospective case series. Eyes with clinically diagnosed posterior polar cataract that had AS-OCT imaging and phacoemulsification were included. Each eye was graded according to the features of the posterior lens opacity and the underlying capsule. Eyes were categorized as having grade 1 or grade 2 cataract depending on the amount of clearance between the posterior opacity and the capsule (≥ 50% clearance and <50% clearance, respectively). Grade 3 represented the absence of an intact posterior capsule. The incidence of intraoperative PCR was compared with the AS-OCT grading to identify eyes at high risk for PCR. The study assessed 37 eyes, 19 with grade 1 cataract, 13 with grade 2, and 5 with grade 3. Posterior capsule rupture occurred in 8 eyes (21.6%), 1 (5.3%) with grade 1 cataract, 4 (30.8%) with grade 2, and 3 (60.0%) with grade 3. The PCR rate was statistically significantly different between the groups (P = .018). When grade 2 cases and grade 3 cases were combined, AS-OCT had a sensitivity of 87.5% and specificity of 62.1%. Anterior segment OCT can be used to grade posterior polar cataracts and identify eyes at high risk for PCR, allowing better surgical planning and preoperative counseling.