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Inverse horse-shoe phaco technique improves visual acuity, lowers risk
Can J Ophthalmol. 2010;45(2):154-156.
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A new phacoemulsification technique minimized risks and enhanced IOL implantation in patients with posterior polar cataracts, according to a study.
The technique involves controlled hydrodelineation followed by viscodelineation and viscodissection during phacoemulsification.
"[The] inverse horse-shoe technique of controlled viscodelineation and viscodissection markedly reduced the risk of posterior capsule rupture," the study authors said. "Moreover, if it occurred, the anterior vitreous face remained intact, so the IOL could be implanted in the sulcus without resorting to anterior vitrectomy."
The prospective interventional study included 28 eyes of 22 patients with posterior polar cataracts. Phacoemulsification was performed under topical anesthesia with controlled hydrodelineation, viscodelineation and viscodissection with minimal stress on the posterior capsule. Hydrodissection was not performed.
The authors recorded preoperative complications and postoperative visual outcomes. The mean follow-up interval was 8 months.
Study data showed posterior capsule rupture occurring in two eyes. Neither eye had vitreous prolapse and did not require anterior vitrectomy. Results showed a statistically significant improvement in mean visual acuity (P = .0001). Low postoperative visual acuity was attributed to amblyopia in three eyes and age-related macular degeneration in one eye, the authors reported.
Posterior polar cataracts are often viewed as an ominous procedure and many cataract surgeons do not want to tackle these cases. However, as this study shows, if one approaches these challenging cases with caution and respect of the fragility of the posterior capsule then they can safely and effectively be performed. This study stresses an important point: Hydrodissection should never be performed in these cases and the use of viscoelastic throughout many steps in the case will improve safety and outcomes. It is imperative to perform a controlled viscodissection of the nucleus from the cortex and capsule and also always try to maintain a stable chamber to avoid or minimize complications with posterior polar cataracts.
– Rosa Braga-Mele, MD, FRCSC
OSN Cataract
Surgery Section Editor