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Oval capsulorrhexis boosts phaco safety in cases of posterior polar cataract
J Cataract Refract Surg. 2011;37(7):1183-1188.
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An oval capsulorrhexis in lieu of a circular capsule opening enabled safe and easy phacoemulsification in cases involving posterior polar cataract with pre-existing posterior capsular rupture, a study found.
"Posterior polar cataract with pre-existing posterior capsule rupture is a clinically distinct entity characterized by a central, dense, disc-shaped opacity located on the posterior capsule with a surrounding opening in the posterior capsule," the study authors said. "Phacoemulsification in this situation is challenging as there is a significant chance of nucleus drop during the surgery."
The technique minimizes turbulence in the capsular bag by increasing the area open to fluid influx. It also enables optic capture of a sulcus-fixated IOL, the authors said.
The technique is performed through a 2.8-mm clear corneal tunnel oriented between the 10 o'clock and 12 o'clock positions. A bent 26-gauge needle is used to create an oval capsulorrhexis about 8 mm × 4.5 mm.
Slow phacoemulsification is performed with low fluid flow rate and low vacuum (60 mm/Hg to 80 mm/Hg). The stop-and-chop technique is used in grade 2 to grade 4 nuclear sclerosis. Phacoaspiration is used in grade 1 nuclear sclerosis. An IOL is located in the bag or sulcus, depending on length of the posterior rupture.
The study included 10 eyes of eight patients; mean patient age was 53 years. After minimum follow-up of 6 months, corrected distance visual acuity improved from 0.221 preoperatively to 0.75 postoperatively. No cases of nucleus drop or cystoid macular edema were reported. All IOLs were stable, the authors said.