• 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