No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification for posterior polar cataracts Tiago Ferreira, Alberto Cardoso Centro Hospitalar de Lisboa Ocidental

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No-hydrodissection, no-hydrodelineation technique
of bimanual microphacoemulsification for
posterior polar cataractsTiago Ferreira,
Alberto Cardoso Centro Hospitalar de Lisboa
Ocidental Ophthalmology department, Lisbon,
PortugalNo financial interest
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No-hydrodissection, no-hydrodelineation technique
of bimanual microphacoemulsification for
posterior polar cataracts

• 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

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No-hydrodissection, no-hydrodelineation technique
of bimanual microphacoemulsification for
posterior polar cataracts

• 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

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No-hydrodissection, no-hydrodelineation technique
of bimanual microphacoemulsification for
posterior polar cataracts
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
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No-hydrodissection, no-hydrodelineation technique
of bimanual microphacoemulsification for
posterior polar cataracts

• Surgical challenges
• More
• zonular dehiscence
• Posterior capsule rupture
• Polar opacity ? Weak, thin or absent posterior
  capsule
• Rupture 7.1 to 36

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No-hydrodissection, no-hydrodelineation technique
of bimanual microphacoemulsification for
posterior polar cataracts

• Pre-operative details ? Inform the patient
• Possible need for further surgical interventions
• Possible need for NdYAG capsulotomy
• Possible amblyopia (especially in unilateral
  cases)

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No-hydrodissection, no-hydrodelineation technique
of bimanual microphacoemulsification for
posterior polar cataracts

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

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No-hydrodissection, no-hydrodelineation technique
of bimanual microphacoemulsification for
posterior polar cataracts

• 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

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No-hydrodissection, no-hydrodelineation technique
of bimanual microphacoemulsification for
posterior polar cataracts
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No-hydrodissection, no-hydrodelineation technique
of bimanual microphacoemulsification for
posterior polar cataracts

• Results
• All eyes with 20/20 VA
• 1 case (25) of posterior capsule rupture
• Sulcus-fixated IOL implanted

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No-hydrodissection, no-hydrodelineation technique
of bimanual microphacoemulsification for
posterior polar cataracts

• 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