Preoperative evaluation of a 45-year-old patient scheduled for phacoemulsification shows a dense posterior polar cataract with a pre-existing defect in the posterior capsule on OCT. Which intraoperative modification is most appropriate?

• A Use high vacuum and burst mode directly over the polar plaque
• B Perform hydrodissection with generous fluid to free the nucleus fully
• C Convert routinely to manual extracapsular extraction through a large incision
• D Avoid hydrodissection, use low flow settings, and be prepared for planned posterior capsule rupture with anterior vitrectomy ✓

Explanation

In posterior polar cataract the polar plaque may be adherent to a weak or absent posterior capsule, so hydrodissection can extend a latent breach into a full rupture. Surgeons avoid hydrodissection, use low aspiration and flow parameters, keep the epinucleus as a protective cushion, and anticipate conversion to anterior vitrectomy. Routine extracapsular conversion is unnecessary when phaco settings are modified appropriately.

Reference: AAO Basic and Clinical Science Course, Lens and Cataract Section 11, 2023-2024 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.