• Introduction

• Posterior polar cataracts

• Sporadic• Inherited

• Bilateral• Autossomal dominant• Cromossomes 16q22, 1p36, 20p12-q12 e 11q22-q22.3•PITX3 gene – controls the development of the anterior segment of the eye

• Degenerative and malformed lens fibers• Surrounded by vacuoles – weakness of and adhesion to the posterior capsule

• Posterior polar cataracts

• Rare, no incidence studies

• Population based analysis - 111 cases against 37,837 controls without ocular defects

• Symptoms – 3rd to 4th decade• Glare, reduced visual acuity

Posterior polar cataracts

Type 1 – Opacity associated with posterior subcapsular cataract

Type 2 – Ring opacity

Type 3 – Opacity with dense white spots at the edge with thin or absent posterior capsule.

Type 4 – Combination of types 1-3 with nuclear sclerosis

• Surgical challenges

• More:• zonular dehiscence• Posterior capsule rupture

• Polar opacity Weak, thin or absent posterior capsule• Rupture – 7.1 to 36%

• Pre-operative details Inform the patient

• Possible need for further surgical interventions

• Possible need for Nd:YAG capsulotomy

• Possible amblyopia (especially in unilateral cases)

• Techniques to avoid complications

• Pars plana lensectomy• Slow motion phaco• No-hydrodissection or hydrodissection in multiple quadrants• Hydrodelineation and no nuclear rotation• Viscodissection

• Methods

• No-hydrodissection no-hydrodelineation technique

• 4 eyes of 2 patients with bilateral posterior polar cataracts• Bimanual microphacoemulsification without hydrodissection or delineation• Posterior capsulorhexis in 2 eyes

• Surgical technique – see video clip

• Results

• All eyes with 20/20 VA

• 1 case (25%) of posterior capsule rupture • Sulcus-fixated IOL implanted

• Conclusion

• Rare type of cataract• Weak posterior capsule• No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification

• Good visual results

• Fewer cases of posterior capsular rupture ? – more studies, with more patients needed