Safety Of Hydrodissection In Posterior Polar Cataract With Intact Posterior Capsule Imaged With Preoperative Swept Source Optical Coherence Tomography

To evaluate the safety of routine hydrodissection in Posterior polar cataract (PPC) with intact posterior capsule imaged using preoperative Swept Source Anterior Segment Optical Coherence Tomography (SS AS- OCT)

Prospective interventional study done at Teritiary Eye care Hospital in South India

The study included eyes with PPC undergoing cataract surgery by standard phacoemulsification / femtosecond platform. Preoperative SS AS-OCT imaging was done to assess posterior capsule (PC), which was then classified as intact (Group 1), discontinuous (Group 2) or open PC (Group 3). In group 1, phacoemulsification was done with routine hydrodissection and nucleus rotation. In group 2, hydrodelineation was done and nucleus rotation was avoided. Chamber stability was maintained and PC polishing was avoided in both groups. The outcome measure was to assess the incidence of Posterior capsular rupture (PCR) in Group 1 and Group 2.

The cohort included 71 eyes (57 patients), which were categorised as Group 1 (54/71[76.1%]), Group 2 (16/71[22.5%]) and Group 3 (1/71[1.4%]) based on preoperative SS AS-OCT. One eye in Group 1 developed PCR (1.9%) with routine hydrodissection and 4 eyes in Group 2 developed PCR (25%) and the one eye in group 3 had PCR (100%). The Negative Predictive Value of SS AS- OCT in predicting intra operative PCR was found to be 98.1%. In the bag placement of IOL was possible in 53 eyes (98%) in group 1, in 13 eyes (81%) in group 2 & one eye (100%) in group 3.

Preoperative SS AS -OCT helps to identify the low -risk PPC with intact PC where gentle hydrodissection and nucleus rotation could be done for efficient nucleus and epinucleus management. Care should be taken to avoid vigorous hydrodissection or nuclear rotation to prevent PCR.