Preoperative evaluation of a 45-year-old man scheduled for phacoemulsification reveals a dense posterior polar cataract. Which intraoperative modification is most appropriate?

• A Perform aggressive hydrodissection to completely separate the nucleus before any ultrasound
• B Avoid or minimise hydrodissection and use low flow settings, since the posterior capsule may be dehiscent beneath the polar opacity ✓
• C Use maximum vacuum throughout to remove the nucleus rapidly
• D Implant an anterior chamber IOL routinely instead of a posterior chamber IOL

Explanation

Posterior polar cataracts are frequently associated with a localised defect or extreme thinning of the posterior capsule directly beneath the opacity, sometimes communicating with a persistent hyaloid remnant. Aggressive hydrodissection can rupture this weak area, so surgeons perform gentle hydrodelineation instead, keep infusion bottle height low, and prepare for possible posterior capsule rupture. Routine AC-IOL implantation offers no benefit when the capsule can be preserved.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.