Handling complications

Catarina Pedrosa MD, Lisbon, Portugal, advised delegates attending the 21st ESCRS Winter Meeting in Maastricht, The Netherlands, on how to avoid problems when performing cataract surgery in posterior polar cataract, and how to solve them once they occur. Dr Pedrosa was speaking during a session entitled 'The Usual Suspects: How to Handle Your First Complications', which was organised by the Young Ophthalmologists Committee. “Posterior polar cataract involves an abnormal adhesion of the posterior capsule to the polar opacity or pre-existing weakness of the capsule, posing a particular challenge for the cataract surgeon because of the risk of posterior capsular rupture,” said Dr Pedrosa. “Traditional hydrodissection should be avoided, replaced instead by hydrodelineation, in which the epinucleus is separated from the nucleus. This forms a cushion between it and the capsule,” she advised.

If the capsule ruptures, do not immediately remove the instruments

An alternative is viscodissection, which also forms a cushion and will help avoid vitreous prolapse into the bag in case of posterior rupture. Rudy Nuijts MD, PhD, Maastricht, The Netherlands, agreed, and said he often takes it a step further, luxating the nucleus into the anterior chamber for removal far away from the posterior capsule. If the capsule ruptures, do not immediately remove the instruments, and especially the irrigation, from the eye. Immediately inject viscoelastic to prevent vitreous from entering the anterior chamber. When placing a sulcus lens, increase the incision size and consider capturing the optic in the anterior capsulotomy. “Treat all posterior polar cataracts as though there is a pre-existing hole in the capsule, performing slow-motion surgery to minimise all risk,” added Dr Pedrosa.