Can preoperative anterior segment optical coherence tomography predict posterior capsule rupture during phacoemulsification in patients with posterior polar cataract?

Gurudatha Pavan Kumar, Palaniswamy Krishnamurthy, Manas Nath, Prabu Baskaran, Muralikrishnan Janani, Rengaraj Venkatesh
Journal of Cataract and Refractive Surgery 2018, 44 (12): 1441-1445

PURPOSE: To determine whether preoperative assessment of posterior capsule integrity using anterior segment optical coherence tomography (AS-OCT) can predict posterior capsule dehiscence in patients with posterior polar cataract having phacoemulsification.

SETTING: Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India.

DESIGN: Prospective observational study.

METHODS: Patients with posterior polar cataract who had phacoemulsification between October 2012 and November 2013 were included in the study. Preoperative AS-OCT imaging was performed to assess the integrity of the posterior capsule. Anterior segment OCT images of the posterior capsule were graded as "intact" or "dehiscent." Phacoemulsification was performed by the same surgeon who was masked from the AS-OCT findings. The integrity of the posterior capsule was evaluated by the surgeon intraoperatively.

RESULTS: The study comprised 64 eyes of 62 patients. Preoperative AS-OCT showed 8 eyes (12.5%) to have probable posterior capsule dehiscence and 56 eyes (87.5%) to have intact posterior capsules. Intraoperatively, the surgeon noted posterior capsule dehiscence in 5 eyes (7.8%) and an intact posterior capsule in 59 eyes (92.2%). The sensitivity and specificity of AS-OCT for detecting posterior capsule dehiscence was 100% and 94.92%, respectively. The negative predictive value of AS-OCT was 100%.

CONCLUSION: Anterior segment OCT with its high negative predictive value can be used successfully to predict the risk for posterior capsule rupture during phacoemulsification in eyes with posterior polar cataract.

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