Sir,

I read with interest the recently published article by Siatiri and Moghimi who performed a preferred technique of phacoemulsification in eyes with posterior polar cataract. This is the first study reporting not a single incidence of posterior capsule rupture associated with phacoemulsification of posterior polar cataracts.1 This is an interesting finding given that has been hypothesized that occasionally the posterior capsule is deficient in the region of the polar opacity.2, 3, 4 This study with 38 cases, however did not find this to be true. The absence of posterior capsule rupture is a remarkable result. I did however feel that some issues that may effect the outcome warrant further discussion.

We are aware that 38 eyes of 23 patients were included in the study. However, information about patient selection, co-existent or previous ocular disease, or surgical intervention, which may influence surgical outcome and an exclusion criteria, would be relevant in interpreting the results. Similarly, no details were provided regarding the possible incidence of other complications excluding posterior capsule rupture following the preferred surgical technique. The range in follow-up period of between 2 and 20 months suggests that further management may have been required for some patients.

Though this technique did prove to be safe, pertaining to the rate of posterior capsule rupture, we are unable to accurately estimate the treatment effect without a comparison to a standard reference by the same surgeon. As we become more aware of the predisposition to posterior capsule rupture with posterior polar cataracts and take the necessary preoperative and intraoperative precautions to minimize the complications, could it be that if the same surgeon had performed careful standard surgery, the incidence of posterior capsule rupture would have been as similarly low.