Phacoemulsification Without Hydro-procedure: A Novel Technique to Deal with Posterior Polar Cataracts.

Purpose: To describe a new phacoemulsification technique without hydro-procedures in patients of posterior polar cataract (PPC) and determine the posterior capsular rate (PCR) and postoperative outcomes.Methods: After capsulorhexis, we insert the phacoemulsification probe inside the eye and shave the cortex and epinucleus within the capsulorhexis area. Then the phaco probe is buried deep into the center, and an anteroposterior crack is fashioned. Then the probe is placed at 7’ o clock to chop away a triangular piece of the nucleus. A similar maneuver is done at a 4' o clock position to take out another piece. The phacoemulsification tip and the chopper are now positioned at the cracked site of the lower fragments. Using the 2 instruments, the fragments are now pushed away and easily emulsified.Results: We conducted a retrospective study with 115 eyes of 77 patients. The mean age of the study population was 51.87 + 14.19 years (range 22-87 years). Out of 77 patients, 39 (50.64%) patients had unilateral PPC, and 38 (49.35%) had bilateral PPC. PCR occurred in 9 eyes (7.82%). Two patients had fragment drop, and only 1 (0.87%) patient was left aphakic. Best-corrected visual acuity (BCVA) at postoperative day 30 was 20/20 or better in 102 (88.69%) eyes, 20/32-20/80 was in 11(9.56%) eyes, and BCVA 20/80-20/200 was in 2 (1.73%) eyes.Conclusion: Phacoemulsification without hydro-procedure is a novel technique that can be successfully implemented in PPC cases and expect an excellent visual outcome.

Pac-Man Method: A New Technique for Nuclear Management Of Posterior Polar Cataract

Purpose We introduce an innovative technique, “Pac-Man”, for the nuclear management of posterior polar cataracts and compare it with “Chop in situ” and “Fishbowl” techniques. Method A total of 60 eyes from 60 patients were randomly assigned to groups A, B, and C, with 20 eyes in each group. Pac-Man, Chop in situ, and Fishbowl techniques were used for groups A, B, and C. In the Pac-Man method, adequate single trench sculpts, and a right-sided lateral sculpt were performed and cracked. The triangular piece was emulsified, after which the rest of the nucleus looked like a “Pac-Man” cartoon. Techniques were compared by age, visual outcome, Posterior Capsule Rupture (PCR), Cumulative Dissipated Energy (CDE), and time of surgery. Result Postoperative BCVA was significantly improved after surgery ( P = 0.0001, paired t-test). Time taken for surgeries were 25 ± 2.57, 30 ± 3.78, 40 ± 3.25 min, the CDE were 10 ± 0.95, 20 ± 1.2, 15 ± 0.48, and the PCR were 0%, 5%, and 10% for group A,B,C respectively. The total number of PCR was 3 out of 60 patients, and the percentage was 5.00%. Conclusion The “Pac-Man” method is a recommended technique due to its visual outcome, reduced surgical time, less CDE, and less chance of PCR.

Special Cases in Cataract Surgery

During phacoemulsification for cataracts, the surgeon may encounter various challenges and should therefore be trained to handle them. This chapter will share an example of clinical cases encountered by the author in clinical practice, which mainly includes the successful implantation of a trifocal intraocular lens in the capsular bag after posterior capsular tear during posterior polar cataract surgery as well as cataract surgery design after corneal refractive surgery, shrinkage, and treatment of capsular opening in patients with retinitis pigmentosa after cataract surgery to provide a reference for clinicians.

Role of No Hydro Phacoemulsification Technique in Management of Posterior Polar Cataract

Posterior polar cataracts (PPC) have always been a challenge for cataract surgeons due to their inherently higher propensity for posterior capsule rupture. Over the years, several technical modifications in cataract surgery have been suggested to enhance safety and reduce the percentage of posterior capsule rupture rates in these posterior polar cataracts. This retrospective study tries to present the role and complications of no hydro phacoemulsification technique in management of posterior polar cataract. Aim: To evaluate the role of prehydro phacoemulsification and partial depth phacoemulsification with hydrodelineation in posterior polar cataract (PPC). Method: Medical records of 100 patients with clinical diagnosis of PPC, who underwent pre hydro phacoemulsification and partial depth phacoemulsification with hydrodelineation, were retrospectively reviewed. Results: The incidence of posterior capsule rupture (PCR) was 8% (8/100): 4 cases occurred during epinucleus removal, 3 cases occurred during IOL implantation, and 1 occurred during OVD removal after the implantation of the intraocular lens into the bag. No nucleus piece or lens materials dropped into the vitreous during cataract surgery, and no obvious postoperative complications were found during follow-up. All patients had improved best-corrected visual acuity (BCVA) 1 month postoperatively. Conclusion: Pre hydro phacoemulsification and partial depth phacoemulsification with hydrodelineation help to reduce the incidence of PCR and achieve satisfactory postoperative outcomes.