Surgical and visual outcome of posterior polar cataract

Introduction: Posterior polar cataract is a rare form of congenital cataract with incidence ranging from 3 to 5 in 10001-2. It is bilateral in 65–80% of the cases with no gender predilection3. Posterior polar cataract presents a special challenge to the surgeon because of its predisposition to posterior capsular dehiscence and possible nucleus drop during surgery. The present study aims to evaluate the surgical outcome of phacoemulsification and manual small incision cataract surgery in patients with posterior polar cataract. Material and Methods: This prospective study included 119 eyes of 118 patients with posterior polar cataract, who underwent surgery at Sagarmatha Choudhary Eye Hospital, Lahan, Nepal, between March 2013 to March 2014. All patients underwent complete ophthalmologic examination including vision, slit-lamp Biomicroscopy, IOP measurement and posterior segment examination. Patients with complicated cataract, glaucoma, corneal opacity/ degeneration, retinal pathology were excluded from the study. Patients were scheduled for cataract surgery either with phacoemulsification or manual SICS with fish hook technique. Informed consent was obtained after explaining the type of surgery and possibility of posterior capsular rupture, a relatively long operative time, secondary posterior segment intervention, and a delayed visual recovery. Results: 119 eyes of 118 patients were included in the study. There were 63 males (53.39%) and 55 females (46.61%). The mean age was 53.24 (range 17-80) years. Among 118 patients 24 patients had other eye operated previously, 2 patients had lost their one eye due to trauma and in remaining 92 patients, 71 patients had bilateral posterior polar cataract (77.17%). Phacoemulsification was performed in 48 eyes and SICS in 71 eyes. The most common intraoperative complication was posterior capsule rupture, seen in 22 eyes (18.49%). Of these, 7 eyes(14.58%) had undergone phacoemulsification, 15(21.13%) had manual SICS. 103 intraocular lenses (86.55%) were implanted in the bag and 16 (13.45%) in the sulcus. 7 (5.89%%) eyes needed anterior vitrectomy. Discussion: Posterior polar cataract is a challenge for the cataract surgeon as these cataracts predispose to PC rents and vitreous loss. In our study the incidence rate of PCR was 14.58% in patients who underwent phacoemulsification and 21.13% in SICS group. Conclusion: Posterior polar cataract is a true challenge for cataract surgeons because of its higher risk for surgical complication. These cataracts need more gentle maneuvering to reduce pressure over the weak posterior capsule. In our study, Posterior capsule rupture occurred more frequently in SICS compared to phacoemulsification and in patients with soft nucleus. Phacoemulsification leads to good visual outcome if done carefully with proper technique advised for PPC. Keyword: PPC, PCR, Vitrectomy