Femtosecond laser-integrated anterior segment optical coherence tomography to detect preexisting posterior capsular dehiscence and increase safety in posterior polar cataracts

Purpose: To determine the efficacy of the femtosecond laser with integrated anterior segment optical coherence tomography (AS-OCT) for the detection of posterior capsular dehiscence in posterior polar cataracts (PPCs). To evaluate the safety of phacoemulsification in these eyes undergoing femtosecond laser–assisted cataract surgery (FLACS). Setting: Centre For Sight Group of Eye Hospitals, a chain of tertiary eyecare hospitals in India. Design: Prospective interventional case series. Methods: The study included eyes with PPCs undergoing FLACS using the CATALYS femtosecond platform. Real-time OCT guidance was used to image the posterior capsule (PC), which was then classified as intact or dehiscent. The femtosecond laser was used for the creation of capsulotomy, nuclear fragmentation, and corneal incisions. In all eyes, the posterior offset (distance between the posterior extent of nucleotomy and the PC) was increased to enable a thick epinuclear cushion. Intraoperative status of the PC was noted, and the specificity and the sensitivity of AS-OCT to detect a preexisting posterior capsular defect was determined. Results: The cohort included 50 eyes (40 patients), in which a posterior capsular discontinuity on AS-OCT was observed in 7 eyes (14%). Five (10%) of these 7 eyes developed an intraoperative posterior capsular rent (PCR) A sensitivity and negative predictive value of 100% was noted. No case of nucleus drop was noted. Conclusions: Femtosecond laser with integrated AS-OCT is a relevant and helpful tool to detect and increase the safety in preexisting posterior capsular dehiscence, alerting the surgeon ahead of phacoemulsification.