Hydro-free Mechanical Delamination for Phacoemulsification in Cases of Posterior Polar Cataracts

Aim: This descriptive study describes a novel technique of hydro-free mechanical delamination during phacoemulsification in posterior polar cataract (PPC) cases. Methods: Fifty-one eyes with PPCs underwent complete anterior and posterior segment evaluation. Hydro-free mechanical delamination technique was done using an intraocular lens (IOL) dialer (Sinskey hook) or a bent cystotome to separate the endonucleus from the epinucleus, followed by safe phacoemulsification. Results: A total of 46 patients (51 eyes) with PPC underwent phacoemulsification between March 2021 and June 2023. Preoperative anterior segment optical coherence tomography (AS-OCT) confirmed intact posterior capsule (PC) in all but one case with pre-existing dehiscence. Most lenses were soft, with three moderately hard nuclei. Mechanical delamination was successfully performed in all cases, more easily in soft nuclei. Intraoperative extension of a pre-existing posterior capsular defect occurred in only one eye. A single-piece IOL was implanted in the bag in all cases, with haptics placed away from the area of posterior capsule rupture where present. Conclusion: The technique of hydro-free mechanical delamination is very helpful in PPC cases, as it is safe in creating a mechanical cushion around the nucleus and epinucleus and facilitates safe phacoemulsification.