Role of preoperative anterior segment optical coherence tomography in identifying intraoperative posterior capsular dehiscence in posterior polar cataract

INTRODUCTION: The presence of preoperative posterior capsular dehiscence in posterior polar cataracts (PPCs) increases the chances of intraoperative posterior capsular rent. Our study aims to demonstrate the efficacy of preoperative anterior segment optical coherence tomography (ASOCT) to predict intraoperative posterior capsular rupture (PCR) in PPC. MATERIALS AND METHODS: This was an observational study including patients within 25–75 years of age, having PPC, undergoing phacoemulsification. ASOCT was done for evaluating preoperative posterior capsular status and was graded as “intact” or “dehiscent, and eventually ,intraoperative-posterior capsular status was noted. STATISTICAL ANALYSIS: SPSS (version 27.0) was used, and P value of ≤ 0.05 was considered statistically significant. RESULTS: ASOCT of 44 eyes had 9 (20.5%) dehiscent posterior capsules and 35 (79.5%) intact. Out of these 9 eyes, 7 (77.8%) had intraoperative PCR and 2 (22.2%) did not. Out of these 35, 34 (97.1%) were actually intact intraoperatively and 1 (2.9%) had intraoperative PCR. The sensitivity and specificity of ASOCT for detecting dehiscence were 94.4% and 87.5%, respectively. The positive and negative predictive values were 97.1 and 77.8, respectively. The diagnostic accuracy of the test was 95.45% with a Chi-square value of 27.01 (P < 0.0001). The diagnostic validity of ASOCT grading for detecting preoperative dehiscence was confirmed. The association between intraoperative PCR and preoperative dehiscence was statistically significant (Chi-square test – P < 0.0001). Our objective was established. DISCUSSION AND CONCLUSION: The demographics and clinical parameters were comparable with other studies. Two eyes with preoperative dehiscence on ASOCT had intact posterior capsule during surgery. The cause can be a dense opacity with increased optical density causing an obscured a clear capsule view on ASOCT, an artifact defect, giving a false impression of dehiscence. One eye who had nondehiscent PC on ASOCT was found to have PCR on the table, which can be due to an extremely thin PC or tightly adherent polar opacity to the capsule. According to our study, the diagnostic accuracy of ASOCT for detecting preoperative dehiscence was 94.4% (sensitivity)and of nondehiscence was 87.5%(specificity). 97.1% of eyes with dehiscence on ASOCT, had actual posterior capsular rent (positive predictive value). To conclude, ASOCT can be used as a reliable diagnostic modality.