1. No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification for posterior polar cataracts Tiago Ferreira, Alberto Cardoso Centro Hospitalar de Lisboa Ocidental – Ophthalmology department, Lisbon, Portugal No financial interest

2. Posterior polar cataracts Sporadic Inherited
No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification for posterior polar cataracts
Introduction
Posterior polar cataracts
Sporadic
Inherited
Bilateral
Autossomal dominant
Cromossomes 16q22, 1p36, 20p12-q12 e 11q22-q22.3
PITX3 gene – controls the development of the anterior segment of the eye
Degenerative and malformed lens fibers
Surrounded by vacuoles – weakness of and adhesion to the posterior capsule

3. Posterior polar cataracts Rare, no incidence studies
No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification for posterior polar cataracts
Posterior polar cataracts
Rare, no incidence studies
Population based analysis cases against 37,837 controls without ocular defects
Symptoms – 3rd to 4th decade
Glare, reduced visual acuity

4. No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification for posterior polar cataracts
Posterior polar cataracts
Type 1 – Opacity associated with posterior subcapsular cataract
Type 2 – Ring opacity
Type 3 – Opacity with dense white spots at the edge with thin or absent posterior capsule.
Type 4 – Combination of types 1-3 with nuclear sclerosis

5. Posterior capsule rupture
No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification for posterior polar cataracts
Surgical challenges
More:
zonular dehiscence
Posterior capsule rupture
Polar opacity  Weak, thin or absent posterior capsule
Rupture – 7.1 to 36%

6. Pre-operative details  Inform the patient
No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification for posterior polar cataracts
Pre-operative details  Inform the patient
Possible need for further surgical interventions
Possible need for Nd:YAG capsulotomy
Possible amblyopia (especially in unilateral cases)

7. Techniques to avoid complications Pars plana lensectomy
No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification for posterior polar cataracts
Techniques to avoid complications
Pars plana lensectomy
Slow motion phaco
No-hydrodissection or hydrodissection in multiple quadrants
Hydrodelineation and no nuclear rotation
Viscodissection

8. No-hydrodissection no-hydrodelineation technique
Methods
No-hydrodissection no-hydrodelineation technique
4 eyes of 2 patients with bilateral posterior polar cataracts
Bimanual microphacoemulsification without hydrodissection or delineation
Posterior capsulorhexis in 2 eyes
Surgical technique – see video clip
No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification for posterior polar cataracts

9. No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification for posterior polar cataracts

10. 1 case (25%) of posterior capsule rupture
No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification for posterior polar cataracts
Results
All eyes with 20/20 VA
1 case (25%) of posterior capsule rupture
Sulcus-fixated IOL implanted

11. Weak posterior capsule
No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification for posterior polar cataracts
Conclusion
Rare type of cataract
Weak posterior capsule
No-hydrodissection, no-hydrodelineation technique of bimanual microphacoemulsification
Good visual results
Fewer cases of posterior capsular rupture ? – more studies, with more patients needed