Application of anterior segment optical coherence tomography to identify eyes with posterior polar cataract at high risk for posterior capsule rupture

PURPOSE: To use anterior segment optical coherence tomography (AS-OCT) to identify eyes with posterior polar cataract at high risk for posterior capsule rupture (PCR) during cataract extraction. SETTING: Hong Kong Eye Hospital, Hong Kong, China. DESIGN: Retrospective case series. METHODS: Eyes with clinically diagnosed posterior polar cataract that had AS-OCT imaging and phacoemulsification were included. Each eye was graded according to the features of the posterior lens opacity and the underlying capsule. Eyes were categorized as having grade 1 or grade 2 cataract depending on the amount of clearance between the posterior opacity and the capsule (>= 50% clearance and <50% clearance, respectively). Grade 3 represented the absence of an intact posterior capsule. The incidence of intraoperative PCR was compared with the AS-OCT grading to identify eyes at high risk for PCR. RESULTS: The study assessed 37 eyes, 19 with grade 1 cataract, 13 with grade 2, and 5 with grade 3. Posterior capsule rupture occurred in 8 eyes (21.6%), 1 (5.3%) with grade 1 cataract, 4 (30.8%) with grade 2, and 3 (60.0%) with grade 3. The PCR rate was statistically significantly different between the groups (P=.018). When grade 2 cases and grade 3 cases were combined, AS-OCT had a sensitivity of 87.5% and specificity of 62.1%. CONCLUSIONS: Anterior segment OCT can be used to grade posterior polar cataracts and identify eyes at high risk for PCR, allowing better surgical planning and preoperative counseling.