Scheimpflug imaging of posterior polar cataracts

Session Details

Session Title: Presented Poster Session: Cataract Surgery Special Cases

Venue: Poster Village: Pod 1

First Author: : S.Virdee UK

Co Author(s): :    R. Patel   D. Beddall   J. Devabattula   R. Nitiahpapand   S. Balal   A. Sharma        

Abstract Details

Purpose:

Cataract surgery for posterior polar cataracts (PPCs) is associated with significant risk of posterior capsular rupture, vitreous loss, and nucleus drop. The surgical challenge is compounded pre-operatively by difficulty in diagnosis, progression monitoring, and risk stratification of PPCs. We report a case series of Scheimpflug imaging of PPCs, to evaluate the potential role of imaging in the mitigation of these pre-operative difficulties.

Setting:

The Scheimpflug imaging and cataract surgeries of all patients in this case series were performed at Bedford Hospital, United Kingdom.

Methods:

Two male and four female patients (ten eyes), median age 53 years old (range 46-58) with suspected PPCs identified on slit lamp examination, underwent Pentacam Scheimpflug imaging (Oculus, Wetzlar, Germany). All information was collected and analysed retrospectively from electronic health records.

Results:

Scheimpflug imaging provided detailed anatomical characterisation in all ten PPCs. In three patients (five eyes), imaging identified significant posterior protrusion, with a simulated posterior lenticonus tear drop sign suggestive of pre-existent posterior capsule deficiency. Some degree of posterior protrusion existed in four eyes, deemed to be surgically insignificant in extent, with nil posterior protrusion in the remainder. Two of the six patients (three eyes) underwent cataract surgery. Hydrodelineation was performed instead of hydrodissection in all procedures, with no intraoperative or postoperative complications. Four of the six patients opted against surgery following risk/benefit counselling, including all with tear drop sign.

Conclusions:

Scheimpflug imaging facilitates diagnosis and characterises anatomy of PPCs. It can identify pre-existing posterior capsule deficiency. Serial Scheimpflug imaging could provide objective monitoring of progression towards higher risk anatomy, help optimise timing of surgery and provide continuity between changes of clinician. By facilitating risk stratification, imaging can help personalise pre-operative counselling. Further work is needed to characterise larger cohorts and to identify and correlate new frameworks for risk stratification with clinical outcomes. To date, this represents the largest such case series we could identify.

Financial Disclosure:

None