A REVIEW OF THE OPTIMAL SURGICAL APPROACH TO POSTERIOR POLAR CATARACTS

Posterior polar cataracts pose numerous challenges for cataract surgeons due to the associated high incidence of posterior capsule rupture. Over the years, various surgical techniques have been suggested to improve safety and reduce posterior capsule rupture rates during phacoemulsification of posterior polar cataracts. This review focuses on providing a comprehensive overview of the various strategies that can be incorporated when taking an anterior approach to phacoemulsification of posterior polar cataracts to minimise the risk of posterior capsule rupture.

A Pubmed and Medline search of relevant literature on the phacoemulsification of posterior polar cataracts was performed.

Keywords used in the search were: posterior polar cataract, phacoemulsification and posterior capsule rupture.

The review highlights a number of surgical techniques that all aim to provide a closed chamber during all stages of phacoemulsification to minimise the risk of posterior capsule rupture. With regards to the incision, the smallest self-sealing incision compatible with the phaco sleeve is recommended. Some studies saw benefit using bimanual microincision surgery. Almost all studies recommended hydrolineation over hydrodissection. A technique known as “inside-out delineation” was proposed in 3 studies that involves injecting fluid through the wall of the main groove once it has been created. All rotational movements should be avoided. Many studies reported success with using viscodissection to help with epinucleus removal whilst some studies suggested manual dry aspiration with the Simcoe cannula.  

Posterior polar cataracts are challenging due to their inherently higher propensity for posterior capsule rupture. This review discusses the strategies that can be employed when using an anterior approach to surgery to minimise the risk of complications.