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Session Title: Surgical Outcomes
Session Date/Time: Monday 07/10/2013 | 08:00-09:30
Paper Time: 08:03
Venue: Auditorium (First Floor)
First Author: : N.Shroff INDIA
Co Author(s): : A. Koul R. Dutta G. Singh A. Shrivastava
To report the technique and the outcomes of surgery for posterior polar cataract
Cataract & Intraocular Lens Implantation Service, Shroff Eye Centre, New Delhi, India.
This prospective study included 56 eyes with posterior polar cataract without any co-morbidity. All eyes underwent pre-operative CCT (central corneal thickness). All cataract surgeries were performed by a single surgeon by a standardized technique, wherein only hydrodelineation but no hydrodissection was done. Intraoperatively, in case of posterior capsule rupture (PCR), the stage of PCR, IOL placement and anterior vitrectomy if done was noted. Any other complications were also noted. In event of a PCR, the posterior segment surgeon took over to complete the vitrectomy by pars plana route maintaining a closed chamber avoiding fluctuations in the anterior chamber. Postoperatively, the eyes were examined by a single observer for CCT, AC reaction (Hogans criteria), IOL centration on day 1. At 1 week and 4 weeks the eyes were evaluated for CCT, AC reaction, IOL centration, presence of CME, UCVA and BCVA. OCT was done in all patients with PCR or CME.
The mean age of patients was 58.62±12.46 years. There were 43 males (76.8%) and 13 females (23.2%). Mean CCT was 515.26±36.22 microns pre-operatively, 572±29.48 microns on day 1, 563±14.85 microns at 1 week and 527±38.10 microns at 4 weeks. PCR occurred in 12 eyes (21.4%). In 8 eyes it occurred during epinucleus removal, in 3 eyes during cortex removal and in 1 eye during wound hydration after IOL implantation. Anterior vitrectomy was required in 7 eyes. In 9 eyes IOL was placed in the sulcus. There was no significant correlation of PCR with either the gender of the patient or the density of the nucleus. AC reaction of 2+ or more was seen in 18 eyes (32.1%) at 1 week with no significant difference between eyes with PCR and those without. There was no AC reaction rate at 4 weeks in any eye. IOL was well centered in all eyes at all visits. The mean logMAR BCVA at 1 week and 4 weeks was 0.08 ± 0.27 and 0.03 ± 0.27 respectively with no significant difference between PCR and non PCR eyes. Clinical CME was present in 1 eyes and OCT documented CME in 2 eyes that had a PCR.
Posterior polar cataracts represent a large subset of non traumatic referrals in our centre. Understanding the principles involved in the phacoemulsification, an appropriate surgical technique, anticipating the possible problems and managing them adequately with a posterior segment backup helped us achieve satisfactory technical and visual outcomes. This study emphasizes the need for thorough counseling of patients and the necessity of a proper posterior segment back-up in eyes with posterior polar cataract.
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