to handel a posterior polar catarct is always a challanging work g for all phacoemulsigfication surgeon. this presentation illustrate how to deal with such difficult cases of posterior polar cataract .

1. My
Technique
to Handle
Posterior
Polar
Cataract
Dr. Sanjay Gupta
M.S. (Ophtho.), FVEI
Agrawal Eye and Skin Hospital, Kota & Bundi

2. Why Posterior polar cataract
important ?
 Strong adherence of the
opacity to posterior
capsule.
 26% chances for a
defective PC
 High rate of
intraoperative PC rupture
(upto 36%)

3. Pre Operative Counselling
 Possibility of nucleus
dropping i.e. Due to PC rent
 Long operative time
 Sec. Posterior
segment intervention
 Delayed visual recovery
 Pre existing amblyopia
sp. In unilateral cases

4. Pre operative evaluation
 Thorough preoperative slit lamp evaluation
 Differentiates PPC and posterior subcapsular
cataract
 White crystalline deposits anterior vitreous
( fish tail sign) – PC defect
 Series of small lens like satellites around the
main central cataract – PC defect

5. Surgical modifications : Anaesthesia
 Peribulbar anesthesia
is preferred
 Risk of complications and
increased surgical time
 To manage PC rupture and
vitreous loss in topical
anesthesia is difficult.

6. Capsulorhexis in PPC
 High viscosity viscoelastics
 Smaller rhexis if soft nucleus.
 Moderate to large rhexis
in hard cataract
- prevent build up of
fluid inside the bag
- if PC rupture – nucleus
can be prolapsed in AC

7. Surgical modifications
 AC should be kept stable
 High viscosity cohesive viscoelastic
 BSS inflow should be non turbulent
 Slow motion phaco
 Low phaco parameters
bottle height -- 50 cm
vaccum -- 150 mm hg
asp. Flow rate -- 20 cc per min
Power higher side to avoid machanical
movement of the nucleus

8. Surgical modifications : HYDRO
PROCEDURE
-hydrodissection should never be
attempted
- controlled hydrodelineation is preferred
to separate nucleus from epinucleus
- inside out hydro delineation
( Vasavada )
- gentle multi quadrant hydrodissection
- do not depress the lens during hydro
procedures

9. Do not do
hydrodissection

10. Inside Out Hydrodelineation

11. Surgical caveats
 Rotation of the nucleus should be
avoided
 Stop and chop OR primary phaco chop
method can be used
 Low flow low vacuum technique
 Power setting on higher side
 Ac well maintained during all procedures
 Layer by Layer phacoemulsification

12. Epinucleus removal
 Most dangerous step
 Peripheral part are engaged and gently
loosened and removed
 Central plaque of epinucleus and cortex
removed at the end
 Inject viscoelastic from the sideport
before withdrawing any phaco or
irrigation handpiece

13. Surgical modifications in
PPC
 Bimanual two port IA
better control
decreased AC turbulence
-Vitreactomy machine s/b ready

15. Conclusion
 Phacoemulsification in PPC is challange
 Should not be attempted by surgeon in the early
part of their learning curve
 Careful preoperative evaluation with slit lamp or
anterior segment OCT
 Proper planning of surgical technique
 Stable AC

16. Conclusion
 Avoid forceful hydrodissection and nucleus
rotation, tapping
 Be careful during irrigation and aspiration
 Detect posterior capsular rupture early and
manage

17. Dr. Sanjay
Gupta
Director & phaco surgeon
Agrawal eye and skin
hospital
Kota & bundi