Posterior Polar Cataracts, How Many Really Require Vitreoretinal Intervention?

Posterior polar cataracts (PPC) are often referred to the vitreoretinal services as there is a higher risk of posterior capsule rupture (PCR) if the capsule is involved.  Determining clinically which cases have an intact posterior capsule can be difficult.   

A tertiary centres experience using preoperative anterior segment optical coherence tomography (AS-OCT) in assessing posterior capsule integrity and therefore which cases are considered high risk for intraoperative PCR. 

The Royal Hallamshire Hospital (RHH) and Northern General Eye Centre (NGEC), Sheffield, UK. 

A retrospective review of electronic patient records (EPR) for PPC cases over a three-year period (between January 2022 and December 2024 inclusive).  Where AS-OCT scans were available, the posterior capsule was graded as intact or disrupted.  These results were compared to surgical outcomes, was there a PCR or not? 

Posterior polar cataracts cases were identified if an EPR diagnosis was recorded as "posterior polar cataract" or "polar cataract".  Patients who had an AS-OCT performed for lens status were included.  Cases were reviewed if "polar" was documented in the patient's EPR summary, and included if a PPC was present and cataract surgery in that eye was discussed.  

Forty-one patients were identified as having a PPC, 16 of these were bilateral cases.  Twenty-two Male, 19 Female.  Twenty-six right and 31 left eyes were included.  Cataract surgery was performed on 42 eyes (15 cases either didn’t want to proceed with surgery or are awaiting surgery).  Of these 42 eyes, 25 had an AS-OCT to assess the integrity of the posterior capsule.  The AS-OCT in 23 eyes showed an intact posterior capsule and they underwent uneventful cataract surgery.  Two eyes were identified as having a disrupted posterior capsule on AS-OCT, both cases had the cataract surgery performed on a vitreoretinal list and in both a PCR occurred and was managed.  

Preoperative AS-OCT is a useful tool in helping to determine which posterior polar cataracts involve the posterior capsule and therefore would benefit from vitreoretinal intervention.  

Our work and the reviewed literature show a high negative predictive value, giving confidence that if a posterior capsule looks intact on an AS-OCT, only a small number of these will lead to a PCR so can be managed by a non-vitreoretinal surgeon.   

Please note this abstract details original work but expands on work presented at BEAVRS 2023.