What lies beneath: Posterior capsular imaging in posterior polar cataracts.

Abstract

This study adhered to the tenets of Declaration of Helsinki, ethics committee clearance was obtained and written informed consent was taken. A 52-year-old male presented with complaints of defective vision in the right eye since one year. Corrected distance visual acuity was 20/80 and 20/40 in the right and left eye, respectively. Slit lamp bio microscopic evaluation revealed a dense posterior polar cataract (PPC) with apparent equator-to equator discontinuity of the posterior capsule (PC) in the right eye [Fig. 1]. Left eye demonstrated an early cataract.Figure 1: Slit lamp image of the crystalline lens showing a posterior polar cataract. A spindle-shaped posterior capsular defect is seen around the polar opacitySwept-source OCT in the IOL Master-700 (Zeiss Medical, Germany) revealed an irregular and discontinuous PC [Fig. 2]. Femtosecond laser assisted cataract surgery with intraocular lens implantation was advised for the right eye. The built-in ASOCT in the Catalys Platform (Johnsons and Johnsons Vision, USA) demonstrated a clear discontinuity of the PC. The system additionally enables the surgeon to adjust the posterior laser offset, leaving a thick epinuclear layer behind, which protects the PC from mechanical and hydraulic turbulence during phacoemulsification [Fig. 3].[1]Figure 2: IOL Master 700 Swept source OCT of the crystalline lens showing a bumpy and irregular posterior capsule with discontinuityFigure 3: Femtosecond laser integrated OCT demonstrating discontinuity of the posterior capsule (arrow) and increased posterior laser offset (arrowhead) of 1000 micronsThe microscope-integrated OCT (MIOCT) (Rescan 700, ZEISS, Germany) showed an intraoperative preexisting break in the PC with herniation of cortical matter in the anterior vitreous [Fig. 4]. Cataract extraction was completed maintaining a closed chamber technique and low parameter fluidics. A discontinuity of the PC with a dome-shaped forward herniation of anterior vitreous face was seen [Fig. 5].Figure 4: MIOCT Showing an obvious PC defect, and possible herniation of cortical matter into the anterior vitreousFigure 5: MIOCT scan taken after nuclear emulsification showing a discontinuity of the PC, and a dome-shaped anteriorly herniating blob of vitreous (arrow)Discussion Imaging of the PC using adjunctive tools allows differentiation of a true PPC from a pseudo-polar opacity in doubtful cases following slit lamp evaluation.[2] Additional information regarding the presence and size of PC discontinuity better prepares a surgeon regarding the increased risk of vitreous loss. Imaging modalities additionally delineate subsequent vitreous loss if any and allow optimal management. In conclusion PC imaging allows safe phacoemulsification in PPC, decreasing the risk of rupture from 36% to 0%,[34] with concomitant use of better machines, fluidics, and Femtolaser Assisted cataract Surgery (FLACS). Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.