Polar Cat with visible oval pre-existing posterior capsular tear

This was a one eyed patient , with the other eye , lost to cataract surgery complications. In this patient we noted a posterior polar cataract with an oval pre-existing tear going across the area of the polar cataract.
It was planned to do phakoemulsification with reduced settings. The Vitreo-retina surgeon was sounded of a possible eventuality and was on standby.
Facial block and retrobulbar block was given looking at the eventuality of requiring a pars plana surgery .
A capsulorrhexis was done but no dydroprocedure was carried out in order not to prevent disturbance of the already compromised posterior capsule. We expected the cortical sheet to stabilise the ripped posterior capsule while we removed the nucleus.
Sculpting was started through the nucleus, very very slowly . After the tunnel was made, the chamber was filled with viscoelastic and a chopper was used to manually scrape and mobilize the pieces of the nucleus to the centre . The phako probe was then re-introduced to emulsify the nuclear fragments. Low bottle height and low vacuum was used throughout the procedure.

Once the nucleus was removed, bimanual anterior vitrectomy was performed through the side port incisions, alternating the vitrectomy cutter between cutting and aspirating modes. Complete cortical cleanup and vitreous management was done.

A multipiece Acrysof IOL was implanted over the CCC, which centred and stabilized without any problem.
Surgery was completed by placing a 10-0 suture at the incision.
Post-op recovery was unremarkable.

Category:

Education

Tags:

• Cataract
• posterior polar
• posterior capsule
• anterior vitrectomy
• IOL on CCC
• phakoemulsification