Detection of Posterior Capsule Integrity in Posterior Polar Cataract during Pre-operative Biometry Using Swept Source OCT

Abstract Aim: To identify eyes with posterior polar cataract at a high risk of posterior capsule rupture (PCR) during pre-operative biometry by using swept-source optical coherence tomography (OCT) based IOL master 700. Settings: Tertiary care ophthalmic hospital. Design: Prospective, observational study. Methods and Material: Eyes clinically diagnosed with posterior polar cataracts (PPC) that have undergone biometry using the IOL master 700 followed by phacoemulsification were included. Posterior capsule (PC) integrity was categorized as intact or dehiscent using IOL master 700 OCT images taken during pre-operative biometry. Intraoperative status of the PC was noted and the sensitivity, specificity, negative predictive value and positive predictive value of IOL master 700 to detect pre-existing posterior capsular dehiscence was determined. Results: One hundred thirteen eyes of 105 patients were included. IOL master 700 OCT images showed intact PC in 105 eyes (88.3%) and PC dehiscence in 14 eyes (11.7%) pre-operatively. Out of the 105 eyes that were identified as intact PC, 101 eyes (96.2%) underwent uneventful surgery. Four eyes (3.8%) eyes had intra-operative PCR which had intact PC on imaging. PC dehiscence was identified in 14 eyes (11.7%) all of which had PCR intraoperatively (100%) which is statistically significant ( P < 0.001). IOL master 700 has a sensitivity of 77.8% and specificity of 100% in detecting eyes with PC dehiscence that are at high risk of PCR. The positive predictive value of detecting posterior capsule dehiscence was 100% and the negative predictive value was 96.2%. Conclusions: IOL master 700 can be effectively used to identify eyes at high risk of PCR during pre-operative biometry.