Posterior Polar Cataract Workup

  • Author: George Plechaty, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Mar 21, 2012
 

Laboratory Studies

Apart from a complete blood count (including hemoglobin and hematocrit), no laboratory examinations have been shown to be necessary prior to posterior polar cataract surgery.

Next

Imaging Studies

A chest radiograph may be obtained prior to surgery.

Previous
Next

Other Tests

A-scan ultrasonography should be performed.

Although routinely done prior to almost all preoperative workups, keratometry readings should be performed to aid in intraocular lens (IOL) calculations.

Electrocardiography should be performed to rule out any associated disorders, which have been mentioned but often do not contraindicate posterior polar cataract surgery.

Previous
Next

Diagnostic Procedures

The diagnosis of a posterior polar cataract is self-evident on slit-lamp examination and does not require special diagnostic procedures beyond a full ophthalmic examination. Slit-lamp examination and pupillary retroillumination allow a good evaluation of the visual significance of the opacity. The anterior vitreous should be examined carefully to ensure that it is free of opacity or capsular adherence.

Previous
Next

Histologic Findings

A posterior polar cataract has been shown to present as an opacity in the subcapsular portion of the lens that consists of malformed, disorganized, and degenerated lens fibers. As these fibers migrate posteriorly from their origin at the equator, increased degenerative changes have been shown as they reach the posterior pole. This results in a dense discoid opacity that is often surrounded by an area of vacuoles and abnormal lens fibers. Often, these abnormal lens fibrils are connected to the underlying posterior capsule.

Previous
Next

Staging

Posterior polar cataracts have not been staged, probably because of their rare occurrence.

At present, the Lens Opacities Classification System (LOCS) uses slit-lamp images to grade color and opalescence, as well as retroillumination images to grade cataracts and posterior subcapsular opacities. Cataract severity is graded on a decimal scale that reportedly shows good correlation between different observers. This system, however, does not specifically deal with posterior polar cataracts.

The literature is sparse on this aspect of posterior polar cataracts. The average practice encounters relatively few cases. Grading of posterior polar cataracts was reported by Forster and colleagues in 2006.[16] Out of 33 patients aged 1 week to 8 years with lens opacities, 3 patients were noted to have posterior polar cataracts. The grading was done subjectively and also objectively with the use of photographs. Grading used a scale of 0-10. Posterior polar cataracts graded a 6 indicated surgical removal.

A suggested concept would be to classify these opacities according to size and density. The size range would be 0.5-3 mm in increments of 0.5 mm. Density would be staged from 1+ to 4+ with increasing density as judged by the ability to visualize the posterior capsule.

Moreover, posterior polar cataracts can sometimes be associated with other lens opacities, which can be classified according to the LOCS.

Finally, the main hindrance in fully adopting a functional grading system for posterior polar cataracts appears to be the small sample sizes used. This is because the entity is rare. The author would be glad to receive case reports, which could be correlated into a meaningful classification algorithm.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

George Plechaty, MD  Clinical Assistant Professor, Department of Surgery, Division of Ophthalmology, University of Hawaii, John A Burns School of Medicine

George Plechaty, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard W Allinson, MD  Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD, is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

J James Rowsey, MD  Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Duke-Elder S. Congenital deformities. Part 2. Normal and Abnormal Development. System of Ophthalmology. Vol III. St. Louis: CV Mosby; 1964.

  2. Parsons JH. The Pathology of the Eye. Vol 3. London: Hodder & Stoughton; 1906.

  3. Bucklers. Klin Monatsbl Augenheilkd. 1935;94:289.

  4. Nordmann J. Biologie du cristallin. Paris: Masson;. 1954.

  5. Summers KM, Withers SJ, Gole GA, Piras S, Taylor PJ. Anterior segment mesenchymal dysgenesis in a large Australian family is associated with the recurrent 17 bp duplication in PITX3. Mol Vis. 2008;14:2010-5. [Medline]. [Full Text].

  6. Vogt G, Horvath-Puho E, Czeizel E. [A population-based case-control study of isolated congenital cataract]. Orv Hetil. Jun 11 2006;147(23):1077-84. [Medline].

  7. Leibowitz HM, Krueger DE, Maunder LR, et al. The Framingham Eye Study monograph: An ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973-1975. Surv Ophthalmol. May-Jun 1980;24:335-610. [Medline].

  8. Taylor HR, West SK, Rosenthal FS, et al. Effect of ultraviolet radiation on cataract formation. N Engl J Med. Dec 1 1988;319(22):1429-33. [Medline].

  9. Hiller R, Sperduto RD, Ederer F. Epidemiologic associations with cataract in the 1971-1972 National Health and Nutrition Examination Survey. Am J Epidemiol. Aug 1983;118(2):239-49. [Medline].

  10. Bidinost C, Matsumoto M, Chung D, et al. Heterozygous and homozygous mutations in PITX3 in a large Lebanese family with posterior polar cataracts and neurodevelopmental abnormalities. Invest Ophthalmol Vis Sci. Apr 2006;47(4):1274-80. [Medline].

  11. Summers KM, Withers SJ, Gole GA, Piras S, Taylor PJ. Anterior segment mesenchymal dysgenesis in a large Australian family is associated with the recurrent 17 bp duplication in PITX3. Mol Vis. 2008;14:2010-5. [Medline]. [Full Text].

  12. Zhang T, Hua R, Xiao W, et al. Mutations of the EPHA2 receptor tyrosine kinase gene cause autosomal dominant congenital cataract. Hum Mutat. May 2009;30(5):E603-11. [Medline].

  13. Addison PK, Berry V, Ionides AC, Francis PJ, Bhattacharya SS, Moore AT. Posterior polar cataract is the predominant consequence of a recurrent mutation in the PITX3 gene. Br J Ophthalmol. Feb 2005;89(2):138-41. [Medline].

  14. Burdon KP, McKay JD, Wirth MG, et al. The PITX3 gene in posterior polar congenital cataract in Australia. Mol Vis. Apr 18 2006;12:367-71. [Medline].

  15. Berry V, Francis PJ, Prescott Q, Waseem NH, Moore AT, Bhattacharya SS. A novel 1-bp deletion in PITX3 causing congenital posterior polar cataract. Mol Vis. 2011;17:1249-53. [Medline]. [Full Text].

  16. Forster JE, Abadi RV, Muldoon M, Lloyd IC. Grading infantile cataracts. Ophthalmic Physiol Opt. Jul 2006;26(4):372-9. [Medline].

  17. Kronenberg A, Blei F, Ceisler E, Steele M, Furlan L, Kodsi S. Ocular and systemic manifestations of PHACES (Posterior fossa malformations, Hemangiomas, Arterial anomalies, Cardiac defects and coarctation of the Aorta, Eye abnormalities, and Sternal abnormalities or ventral developmental defects) syndrome. J AAPOS. Apr 2005;9(2):169-73. [Medline].

  18. Das S, Khanna R, Mohiuddin SM, Ramamurthy B. Surgical and visual outcomes for posterior polar cataract. Br J Ophthalmol. Nov 2008;92(11):1476-8. [Medline].

  19. Lim Z, Goh J. Modified epinucleus pre-chop for the dense posterior polar cataract. Ophthalmic Surg Lasers Imaging. Mar-Apr 2008;39(2):171-3. [Medline].

  20. Mistr SK, Trivedi RH, Wilson ME. Preoperative considerations and outcomes of primary intraocular lens implantation in children with posterior polar and posterior lentiglobus cataract. J AAPOS. Feb 2008;12(1):58-61. [Medline].

  21. Vajpayee RB, Sinha R, Singhvi A, Sharma N, Titiyal JS, Tandon R. 'Layer by layer' phacoemulsification in posterior polar cataract with pre-existing posterior capsular rent. Eye (Lond). Aug 2008;22(8):1008-10. [Medline].

  22. Lim Z, Goh J. Modified epinucleus pre-chop for the dense posterior polar cataract. Ophthalmic Surg Lasers Imaging. Mar-Apr 2008;39(2):171-3. [Medline].

  23. Hoffer KJ, McFarland JE. Intracameral subcapsular fluorescein staining for improved visualization during capsulorhexis in mature cataracts. J Cataract Refract Surg. Jul 1993;19(4):566. [Medline].

  24. Chylack LT Jr, Wolfe JK, Singer DM, et al. The Lens Opacities Classification System III. The Longitudinal Study of Cataract Study Group. Arch Ophthalmol. Jun 1993;111(6):831-6. [Medline].

  25. Eshaghian J, Streeten BW. Human posterior subcapsular cataract. An ultrastructural study of the posteriorly migrating cells. Arch Ophthalmol. Jan 1980;98(1):134-43. [Medline].

  26. Fine IH. Cortical cleaving hydrodissection. J Cataract Refract Surg. Sep 1992;18(5):508-12. [Medline].

  27. Hayashi K, Hayashi H, Nakao F, Hayashi F. Outcomes of surgery for posterior polar cataract. J Cataract Refract Surg. Jan 2003;29(1):45-9. [Medline].

  28. Nagata M, Matsuura H, Fujinaga Y. Ultrastructure of posterior subcapsular cataract in human lens. Ophthalmic Res. 1986;18(3):180-4. [Medline].

  29. Osher RH, Yu BC, Koch DD. Posterior polar cataracts: a predisposition to intraoperative posterior capsular rupture. J Cataract Refract Surg. Mar 1990;16(2):157-62. [Medline].

  30. Pandey SK, Werner L, Escobar-Gomez M, Werner LP, Apple DJ. Dye-enhanced cataract surgery. Part 3: posterior capsule staining to learn posterior continuous curvilinear capsulorhexis. J Cataract Refract Surg. Jul 2000;26(7):1066-71. [Medline].

  31. Streeten BW, Eshaghian J. Human posterior subcapsular cataract. A gross and flat preparation study. Arch Ophthalmol. Sep 1978;96(9):1653-8. [Medline].

  32. West SK, Rosenthal F, Newland HS, Taylor HR. Use of photographic techniques to grade nuclear cataracts. Invest Ophthalmol Vis Sci. Jan 1988;29(1):73-7. [Medline].

 
Previous
Next
 
The posterior polar cataract is seen as a dense discoid opacity. The central fibrous mass consists of degenerated lens fibers surrounded by several small globular vacuoles containing what appears as a refractile substance as well as some lens degenerative fiber material.
Removal of the nucleus and much of the cortex has been completed with the aid of hydrodissection. Almost all of the posterior cortical opacity has also been aspirated. Only indirect irrigation and aspiration was used. Hydrodelineation has been avoided. There appears to be a ringlike remnant of the opacity that may have some adherence to the capsule.
Removal of the nucleus and much of the cortex has been completed. Highly dilute fluorescein dye has been instilled to stain the remaining epinucleus but especially the remaining ringlike opacity. The capsule is still intact since the stain is limited to the anterior chamber. This aids in careful cortical aspiration without damage to the intact posterior capsule.
Aspiration of the subincisional cortex is shown. The dye in the remaining ringlike edge of the cataract, at the 10-o'clock position, appears to show a small strand still adhering in the direction of the posterior capsule. A defect in the capsule has been avoided up to this point.
After careful cortical aspiration, a posterior chamber lens is shown. The capsule has remained intact.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.