Assessment of posterior capsule integrity in posterior polar cataracts usinganterior segment OCT

Background: Posterior polar cataracts (PPC) pose a great surgical challenge to ophthalmic surgeons. Main intraoperative surgical
concerns are increased risk of posterior capsular rupture (PCR), vitreous loss, and nuclear drop. Traditional assessment of posterior
capsule integrity utilizing anterior segment- optical coherence tomography (AS‑OCT) requires training, and it is a time‑consuming
process. Recent techniques of posterior capsule assessment need additional software installation, raising the cost of investigation for
the patient. This video demonstrates a time‑saving method to assess posterior capsular integrity using regular AS‑OCT, which can be
learnt and practiced easily in outpatient department (OPD). Purpose: Ultrasound and 20 D lens mounted on posterior segment optical
coherence tomography (OCT) are some of the popular methods to assess the posterior capsule. Such techniques need training and
are laborious. Our technique used to assess posterior capsule integrity in PPC using AS‑OCT is simple, time saving, and can be easily
practiced. Synopsis: The technique described requires AS‑OCT lens to be mounted on the lens aperture. The console panel is set to
scan on scleral mode. AS‑OCT is advanced to capture the cornea, anterior capsule, and posterior capsule. Intact posterior capsule is
visualized as a continuous well‑defined hyper‑reflective layer, and any break in the continuity of this hyper‑reflective layer suggests
posterior capsule dehiscence, which can further be studied based on literature classifications. Highlights: (1) Importance of proper
preoperative assessment in cases of PPC. (2) Detailed technique of using anterior segment OCT module in acquiring scans of posterior
capsule in PPC. (3) How to find whether the posterior capsule is intact versus dehiscent. (4) Clinical cases showing utility of this
technique. (5) Uses and benefits

[@Vikram.Madan.]

In case there is a pre existing rent, and the surgery is being performed by FEMTO LASER CATARACT SURGERY, which leaves an offset margin of 800 microns, what are the chances of nucleus drop in this case ?