Stratified Phacoemulsification Technique to Enhance Safety in Posterior Polar Cataracts.

Purpose: To describe a new technique of stratified phacoemulsification of the nucleus to protect the vulnerable posterior capsule in posterior polar cataracts.

Setting: Dr Om Parkash Eye Institute, Amritsar, India.

Design: Prospective interventional study.

Methods: Twenty-six eyes of twenty-two patients with posterior polar cataracts and nuclear sclerosis of Grade 2 and above, undergoing phacoemulsification surgery, were included in the study. No hydro procedures were performed intentionally to prevent the pressure build-up within the bag or the occurrence of accidental hydrodissection in any of the eyes. Stratified separation was used to separate the nucleus from the surrounding epinucleus mass along natural separational planes in moderate to hard nuclei. Nuclear fragment was emulsified, leaving the epinucleus shell intact. This process of stratified separation and emulsification was repeated for all nuclear fragments without disrupting the epinucleus shell. The epinuclear shell acted as a scaffold and prevented fluidic turbulence and mechanical forces transmission to the fragile posterior capsule. Finally, the epinucleus shell and cortical lens matter were aspirated, and an intraocular lens was implanted.

Results: Our technique of stratified phacoemulsification, which entails chopper-assisted manual delineation of the nucleus, yielded excellent outcomes. Our study included Twenty-six eyes of twenty-two patients with posterior polar cataract and nuclear sclerosis grade 2 or higher. Posterior capsular rupture occurred in one case, which showed pre-existing dehiscence with a moth-eaten appearance on Anterior Segment Optical Coherence Tomography. The pre-existing posterior capsular rent did not result in any intraoperative complications.

Conclusion: The technique of stratified phacoemulsification can achieve safe and successful cataract surgery in posterior polar cataracts with Grade 2 or higher nuclear sclerosis, without the use of hydro maneuvers or expensive femtosecond lasers. The technique entails using standard instruments to form an epinuclear shell that protects the posterior capsule during nuclear emulsification.