Eyeworld

EW RESIDENTS 56 December 2018 EyeWorld journal club by Benjamin Young, MD, Venkatesh Brahma, MD, Emily Li, MD, Marez Megalla, MD, Andrew Pouw, MD, and Jessica Chow, MD likely to rupture during removal of posterior polar cataracts. This prospective study evaluated 64 eyes from 62 patients of the Aravind Eye Hospital in Pondicherry, India, who carried a diagnosis of PPCs of a maximum of 4 mm diameter and who underwent phacoemulsification cataract surgery. The study exclud- ed patients with factors that may complicate cataract surgery, such as posterior capsular tear identifiable at the slit lamp, pseudoexfoliation, dense, posterior subcapsular or cortical cataract, or previous ocular trauma. AS-OCT images of the PPCs were obtained and the states of the PCs were assessed by a single observ- er. Capsules were deemed "intact" if the capsular margin was visualized below the PPC without any defects years. 11 In the event of PC rupture, lens fragments can fall posteriorly into the vitreous cavity. Retained lens fragments result in sequelae such as persistent inflammation, vit- reous loss, cystoid macular edema, and retinal detachment. Successful surgical management of PPCs requires careful evaluation and planning at each stage of the process to minimize the risk of pos- terior capsular rupture and dropped lens. Preoperatively, surgeons should counsel patients in great detail about the risk of lens drop and potential need for additional vitreoretinal surgery. However, until now, there has not been an objective method with which to stratify the risk of this complication. Kumar et al. assessed the utility of anterior optical coherence tomog- raphy (AS-OCT) in preoperatively identifying patients whose PCs are A posterior polar cataract (PPC) is a rare congenital cataract with an inci- dence of approximately 3 to 5 in every 1000. 1 PPCs usually form early in life, either during embryogenesis or during infancy, caused by abnormalities in normal lens development associ- ated with remnants of the hyaloid system. 1 Multiple case series have suggested a possible autosomal dominant pattern of inheritance. 2–8 Noted to be bilateral in 60–85% of cases, 1 they can be visually signifi- cant as they usually lie at the nodal point of the eye. PPCs are classically described as a dense, white, thick, discoid opacity in the central aspect of the posterior lens with a whorled appearance, likened to the layers of an onion or a bull's eye target. Clinically, PPCs are classified into two types: stationary or progressive. Stationary PPCs account for approx- imately 65% of PPCs and stay stable in size and appearance over time, with minimal change in symptoms. Progressive PPCs account for 35% of PPCs and have enlarging circular radiations with time, thus leading to worsening symptoms. Symptoms include significant glare and halos, which usually improve with mydri- asis. The treatment for a visually significant PPC is surgical; however, given the higher risk of posterior capsular (PC) rupture in PPC, cata- ract extraction poses a challenge for the surgeon. 9 The incidence of PC rupture in PPC surgery ranges from 26% to 36% in older studies, which has im- proved to 4–7% in more recent re- ports. 10 Independent risk factors for PC rupture include PPC >4 mm in diameter and age younger than 40 Review of "Can preoperative anterior segment optical coherence tomography predict posterior capsule rupture during phacoemulsification in patients with posterior polar cataract?" continued on page 58 Jessica Chow, MD, residency director, Yale School of Medicine The question of whether OCT can predict capsular rupture with pos- terior polar cataracts is answered in this very large series compiled at Aravind. I asked the Yale residents to review this important study that appears in the December issue of JCRS. —David F. Chang, MD, EyeWorld journal club editor Yale School of Medicine residents, from left: Venkatesh Brahma, MD, Emily Li, MD, Benjamin Young, MD, and Marez Megalla, MD Source: Yale School of Medicine

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