Safety of hydrodissection in low-risk posterior polar cataract assessed with preoperative swept-source optical coherence tomography

Purpose: To evaluate the safety of routine hydrodissection in a subset of posterior polar cataracts (PPC) in which the posterior capsule (PC) can be visualized beneath the polar opacity using preoperative swept-source anterior segment optical coherence tomography (SS-AS-OCT). Design: Prospective interventional study. Methods: The study included eyes with PPC undergoing cataract surgery by standard phacoemulsification or femtosecond laser platform. Preoperative SS-AS-OCT imaging was performed to assess the PC, which was then classified as continuous (Group 1), abrupt (Group 2), or dehiscent PC (Group 3). PPC with dehiscent PC was excluded. In Group 1, phacoemulsification was performed with routine hydrodissection and nuclear rotation. In Group 2, hydrodelineation was performed, and nucleus rotation was avoided. Chamber stability was maintained, and PC polishing was avoided in both groups. The outcome measure was to assess the incidence of posterior capsular rupture (PCR) in Groups 1 and 2. Results: The cohort included 70 eyes (57 patients), categorized as Group 1 PPC [54 eyes (77.1%)] and Group 2 PPC [16 eyes (22.9%)] based on preoperative SS-AS-OCT imaging. One eye in Group 1 developed PCR (1.9%) with routine hydrodissection, and four eyes in Group 2 developed PCR (25%). The negative predictive value of SS-AS- OCT with gentle hydrodissection was 98.1%. Conclusion: Preoperative SS-AS -OCT helps identify low-risk PPC cases, in which gentle hydrodissection and nucleus rotation can be performed for efficient nucleus and epinucleus management.