Aa
Cataract and Astigmatism
Hello
I am 35 years old.
I have a polar posterior subcapsular cataract in my right eye (diagnosed in 2013). I got pregnant in Dec 2013 and by the 4th month (March 2014), the vision in right eye deteriorated so that I could only see 20/80. I also had swine flu in January of 2014 in my first trimester and the cough and symptoms lasted till end of February.
I went for an eye checkup in March 2014 to check on the decreased vision and increase in number of floaters. I was told that there was some vitreous detachment and the cataract was responsible for the decreased vision. The retina looked fine as per the doctor.
No refraction test was done. I visited an ophthalmologist recently(Jan 2015) who did a pinhole test and said in addition to the cataract, I also have some refraction.
Could the pregnancy and swine flu have caused the refraction and the increased floaters (vitreous detachment)? The cough was so bad that I could not sleep for weeks.
I delivered my baby Sep 11 2014. There has been no change in my vision in the right eye.
Since I have better vision with the pinhole, will glasses help till I do the cataract surgery?
Appreciate any feedback from this wonderful community!
I am 35 years old.
I have a polar posterior subcapsular cataract in my right eye (diagnosed in 2013). I got pregnant in Dec 2013 and by the 4th month (March 2014), the vision in right eye deteriorated so that I could only see 20/80. I also had swine flu in January of 2014 in my first trimester and the cough and symptoms lasted till end of February.
I went for an eye checkup in March 2014 to check on the decreased vision and increase in number of floaters. I was told that there was some vitreous detachment and the cataract was responsible for the decreased vision. The retina looked fine as per the doctor.
No refraction test was done. I visited an ophthalmologist recently(Jan 2015) who did a pinhole test and said in addition to the cataract, I also have some refraction.
Could the pregnancy and swine flu have caused the refraction and the increased floaters (vitreous detachment)? The cough was so bad that I could not sleep for weeks.
I delivered my baby Sep 11 2014. There has been no change in my vision in the right eye.
Since I have better vision with the pinhole, will glasses help till I do the cataract surgery?
Appreciate any feedback from this wonderful community!
Hi Shir!! Found your post while researching for myself.. I am 31, anomolychick mentioned me in her post to you.. I actually was told I had cataracts at 29, while pregnant. I didn't have a refractive error to really speak of before that (-1.00 maybe? But i never wore glasses)... I went in for an exam while in my 8th month of pregnancy and my vision was much blurrier and they told me "you have cataracts"--- the only explanation I have is that I used heavy duty steroid drops for 2 years due to eye inflammation that turned out to be thyroid related. I would get severe episcleritis out breaks which have caused me to no longer be able to wear makeup, etc as I'm very senItive now.
Anyways.. I had my daughter in august 2013, and my eyes suddenly became extremely blurry. I went to a -4.5 contact lens, and as each month passed it was dropping back down... I now am back to about a -1.00 but the cataract causes this to be even blurrier- stronger glasses don't help because it's not a reflective error it's the cataracts. Highly annoying lol..
I just wanted to offer some support! Feel free to message me to talk about these things in more detail if interested and maybe I can help you? I am probbaly going to be having surgery in the next year or so.. I have many reservations about it but trying to be optimistic!!!
I do agree with anomolychick that my pregnancy seemed to cause my lens to swell up and retain water... Then as the water retention went down, so did my lens. Very strange lol
Anyways.. I had my daughter in august 2013, and my eyes suddenly became extremely blurry. I went to a -4.5 contact lens, and as each month passed it was dropping back down... I now am back to about a -1.00 but the cataract causes this to be even blurrier- stronger glasses don't help because it's not a reflective error it's the cataracts. Highly annoying lol..
I just wanted to offer some support! Feel free to message me to talk about these things in more detail if interested and maybe I can help you? I am probbaly going to be having surgery in the next year or so.. I have many reservations about it but trying to be optimistic!!!
I do agree with anomolychick that my pregnancy seemed to cause my lens to swell up and retain water... Then as the water retention went down, so did my lens. Very strange lol
Thank you very much for your kind words and support. This forum has given me a lot of information, hope and courage.
Hello, I am so sorry that you are going through this. I had a cataract surgery on my left eye done at See By Intravision (Oakville). But, I didn’t have the burden of anxiety or fear since my doctor explained me each stage to be undertaken clearly and specifically. It was a piece of cake and everything came up really well. I am happy at my choice of going for the surgery and hope you would be able to take the right decision.
Hello, I am so sorry that you are going through this. I had a cataract surgery on my left eye done at See By Intravision (Oakville). But, I didn’t have the burden of anxiety or fear since my doctor explained me each stage to be undertaken clearly and specifically. It was a piece of cake and everything came up really well. I am happy at my choice of going for the surgery and hope you would be able to take the right decision.
Thank you very much for the feedback..I believe I also developed cataracts as I took medication for skin allergies/asthama when I was younger..
Another reason maybe that for the 3 years preceding the diagnosis, I used to watch long hours of movies on netflix in total darkness, very close to eyes...Not sure if the radiation/blue light triggered the cataracts to become worse...Of course, in hindsight it was a very foolish thing to abuse my eyes so but since I had never worn glasses before, I thought myself invincible.
I will keep the pregnancy related refraction in mind..if I can see enough to continue working (I am a business analyst in IT) I can delay the surgery ..every year there are new advancements in technology and something not available today may be available tomorrow..it amazes me, the things we create/invent/discover every day.
Another reason maybe that for the 3 years preceding the diagnosis, I used to watch long hours of movies on netflix in total darkness, very close to eyes...Not sure if the radiation/blue light triggered the cataracts to become worse...Of course, in hindsight it was a very foolish thing to abuse my eyes so but since I had never worn glasses before, I thought myself invincible.
I will keep the pregnancy related refraction in mind..if I can see enough to continue working (I am a business analyst in IT) I can delay the surgery ..every year there are new advancements in technology and something not available today may be available tomorrow..it amazes me, the things we create/invent/discover every day.
While I cannot speak for your situation, I did meet someone on this forum who developed cataracts at 30. She was on steroid eye drops for some kind of inflammation from her eye makeup and got pregnant. While she was pregnant, her refraction went from plano to -6.00 together with the development of bilateral cataracts. The doctors told her it was caused by the cataract. (Typically it is as the change in the lens structure can cause it to swell) In her case, a year and half after she delivered her refraction returned to normal. The cataracts remained however, and she is currently deliberating over what to do. I think the pregnancy may have somehow caused her lenses to retain water. Either way, it doesn't really matter. They need to come out regardless of what caused it.
Actually astigmatism can come from a variety of components of the eye as this page discusses in detail:
http://eyewiki.aao.org/Physiology_of_Astigmatism
Although the usual major factor in astigmatism is the cornea, the lens can often be a factor, lenticular astigmatism. A cataract's impact on the lens isn't always merely "clouding" the vision and reducing the light that flows in, the cataract can also bend the light as well to cause changes in refraction such as adding more astigmatism (as it did in my case) or changing the focal point as it did in my case where it made that eye much more myopic.
http://eyewiki.aao.org/Physiology_of_Astigmatism
Although the usual major factor in astigmatism is the cornea, the lens can often be a factor, lenticular astigmatism. A cataract's impact on the lens isn't always merely "clouding" the vision and reducing the light that flows in, the cataract can also bend the light as well to cause changes in refraction such as adding more astigmatism (as it did in my case) or changing the focal point as it did in my case where it made that eye much more myopic.
Cataract is a clouding of the focusing lens of the eye. The cornea is the clear window of the eye through which light must pass first to reach the lens and then proceed on to reach the retina which acts like the film in a camera to capture what we see.
An astigmatism is an irregularity in the curvature of the cornea (somewhat like a wobble in a bowling ball) and this wobble causes images to be distorted when they reach the retina and thus makes a blur. Most astigmatism can be corrected with spectacles or contact lenses.
An astigmatism is an irregularity in the curvature of the cornea (somewhat like a wobble in a bowling ball) and this wobble causes images to be distorted when they reach the retina and thus makes a blur. Most astigmatism can be corrected with spectacles or contact lenses.
Of course, Singapore is a huge distance to travel for this kind of surgery. No, you don't have to come to me for surgery and I do not post information on this forum expecting people to do so.
India is a huge place. But I know of 2 well known and well regarded (among his peers) surgeons, one in Ahmedabad and the other in Hyderabad. I have met them personally and looked at their surgeries. I would prefer not to mention names here so do send me a message if you are interested.
India is a huge place. But I know of 2 well known and well regarded (among his peers) surgeons, one in Ahmedabad and the other in Hyderabad. I have met them personally and looked at their surgeries. I would prefer not to mention names here so do send me a message if you are interested.
Do you remember the name of the hospital that had the symphony lens?
I did email Dr Chang for a doctor referral in Madison. I can probably ask him for a contact in India.
You are right about Aravind Ashram. Its mostly for poor people.
At this time, fortunately, I do not have to worry about the cost much. My criteria is a good surgeon.
I did email Dr Chang for a doctor referral in Madison. I can probably ask him for a contact in India.
You are right about Aravind Ashram. Its mostly for poor people.
At this time, fortunately, I do not have to worry about the cost much. My criteria is a good surgeon.
re: "based on how much time it took for the other eye to deteriorate"
Its hard to say if that is necessarily the case, since when my eye with the problem cataract began having trouble, there were trace signs of the start of a cataract in the other eye. Yet unlike the few months it took the first to interfere with vision bad, 2.5 years later the other one was still barely noticeable to the eye doctor. Just in case I was prepared for the idea that it might suddenly deteriorate, I hadn't expected instead to just have trouble ignoring the bad eye.
re: "or in India as I am still an Indian citizen"
Oh, that explains your reference to surgery in India before. I hadn't evaluated the quality of the clinic once I discovered I'd need to get a visa to go there (which may be easy, I just didn't check). However out of curiosity I did get one quote from an Indian clinic that had the new Symfony lens (which is a likely indication they are modern since they were using the latest lens) for surgery of only 60,000 rupees per eye which (according to Google's conversion) is $977.39 per eye. I don't know though how their care compares to western standards, I suspect in a large country like that there are enough wealthy people that their top tier facilities are likely comparable but likely still lower cost than here.
I do remember seeing a reference to a well known American cataract surgeon having a connection in India, I don't know if he is too busy or if he might be able to steer you to a possibility there:
http://www.changcataract.com/los-altos/humanitarian-eye-surgery.htm
"Being a “household name” in the field of cataract surgery, Dr. Chang has used his international prominence to highlight and advance several important humanitarian cataract efforts. He is on the medical advisory board of both Project Vision (China) and the Himalayan Cataract Project (Asia), and also consults for the Aravind Eye Hospital System in India. "
I don't know if the hospital he is connected with is mostly focused on high volume for poorer patients rather than state of the art treatment. I do remember reading that they had a 2 tier system where they do have wealthier patients, often from other countries, pay more and that funds the care for the poor. I don't know however whether the higher tier is high quality by American standards. If you do a search for "best indian eye clinics" they did turn up in one list. This medical tourism site mentions other clinics there "known for exceptional work":
http://www.patientsbeyondborders.com/procedure/ophthalmology
Its hard to say if that is necessarily the case, since when my eye with the problem cataract began having trouble, there were trace signs of the start of a cataract in the other eye. Yet unlike the few months it took the first to interfere with vision bad, 2.5 years later the other one was still barely noticeable to the eye doctor. Just in case I was prepared for the idea that it might suddenly deteriorate, I hadn't expected instead to just have trouble ignoring the bad eye.
re: "or in India as I am still an Indian citizen"
Oh, that explains your reference to surgery in India before. I hadn't evaluated the quality of the clinic once I discovered I'd need to get a visa to go there (which may be easy, I just didn't check). However out of curiosity I did get one quote from an Indian clinic that had the new Symfony lens (which is a likely indication they are modern since they were using the latest lens) for surgery of only 60,000 rupees per eye which (according to Google's conversion) is $977.39 per eye. I don't know though how their care compares to western standards, I suspect in a large country like that there are enough wealthy people that their top tier facilities are likely comparable but likely still lower cost than here.
I do remember seeing a reference to a well known American cataract surgeon having a connection in India, I don't know if he is too busy or if he might be able to steer you to a possibility there:
http://www.changcataract.com/los-altos/humanitarian-eye-surgery.htm
"Being a “household name” in the field of cataract surgery, Dr. Chang has used his international prominence to highlight and advance several important humanitarian cataract efforts. He is on the medical advisory board of both Project Vision (China) and the Himalayan Cataract Project (Asia), and also consults for the Aravind Eye Hospital System in India. "
I don't know if the hospital he is connected with is mostly focused on high volume for poorer patients rather than state of the art treatment. I do remember reading that they had a 2 tier system where they do have wealthier patients, often from other countries, pay more and that funds the care for the poor. I don't know however whether the higher tier is high quality by American standards. If you do a search for "best indian eye clinics" they did turn up in one list. This medical tourism site mentions other clinics there "known for exceptional work":
http://www.patientsbeyondborders.com/procedure/ophthalmology
yes, I noticed that about wanlien, after I had posted my question. I do not have plans to travel to Singapore. It will either be here in US or in India as I am still an Indian citizen.
The good eye is showing signs of the cataract as well and based on how much time it took for the other eye to deteriorate, I can guess that the good eye will be affected in another year or before that.
Hence I am trying to finalize a surgeon so that I can act quickly as you said.
I have an evaluation on Feb 3rd. Hopefully will get an update on the status of my eyes then.
The good eye is showing signs of the cataract as well and based on how much time it took for the other eye to deteriorate, I can guess that the good eye will be affected in another year or before that.
Hence I am trying to finalize a surgeon so that I can act quickly as you said.
I have an evaluation on Feb 3rd. Hopefully will get an update on the status of my eyes then.
I performed the surgery in the beginning of December in Sweden. The sight is good. I need reading glasses for very small letters/and or dark reading conditions.
I have halos. I see perfect rings from cars backlight.
I am also light sensitive so any light letters on TV text (white on black) or light areas, have a lighter area around the light area. This is the most disturbing phenomena for me bcs I experience this like blurriness even though I see sharp as soon as the TV-screen is more dark.
I hope that the halos and the light "fluffy" areas will disappear in a few months to come.
I have halos. I see perfect rings from cars backlight.
I am also light sensitive so any light letters on TV text (white on black) or light areas, have a lighter area around the light area. This is the most disturbing phenomena for me bcs I experience this like blurriness even though I see sharp as soon as the TV-screen is more dark.
I hope that the halos and the light "fluffy" areas will disappear in a few months to come.
FYI, if you note the profile, wanlien3 is unfortunately in Singapore (which isn't a low cost country for medical care). Since he isn't a US-certified doctor he isn't officially labeled as a doc on this site. From what I've seen he is very sharp, reasonable, and good about focusing on evidence based medicine, I'd have considered using him if I'd had other reasons to go to Singapore at the time. Surgical skills and experience of course are relevant in addition to clinical judgement and he echoed my point out about experience handling PCR, and presumably handling this type of cataract, being the main issue.
In terms of how long to wait, as people say it is up to you when the cost&risk is worth the benefit depending on how much the visual problems are impacting you. Since I also had a problem cataract in just one eye, I think one big issue is whether the bad eye is impacting your overall vision much or if your good eye makes the issue not very noticeable. In my case I effectively was just tuning out the bad eye for a couple of years and seeing just fine out of the good eye so I was able to delay surgery while waiting on a better lens to be approved in the US. Very occasionally I'd have momentary blur when the brain seemed to be confused I guess over which eye to pay attention to. Obviously ideally its best to play it safe and have good vision in both eyes. In addition even with 20/20 vision in good lighting, the cataract can cause poorer vision in dimmer lighting in addition to glare, etc.
The issue if you wait due to having one good eye is of course to carefully watch for problems in the good eye and be prepared to act quickly if your vision degrades in your other eye, or if you stop being able to tune out the bad eye for any reason. I hadn't realized that might happen and hadn't expected this, but eventually when the bad eye got worse I had trouble tuning it out. I had thought it would just suppress the bad eye's image indefinitely so I'm not sure what it was, whether perhaps once the image got too color-shifted/blurry the brain had trouble realizing they were both the same image (in which case it would just take the better image and ignore the other) and was confused thinking they were two different images and not being sure which to use, or what explained the difficulty.
In terms of how long to wait, as people say it is up to you when the cost&risk is worth the benefit depending on how much the visual problems are impacting you. Since I also had a problem cataract in just one eye, I think one big issue is whether the bad eye is impacting your overall vision much or if your good eye makes the issue not very noticeable. In my case I effectively was just tuning out the bad eye for a couple of years and seeing just fine out of the good eye so I was able to delay surgery while waiting on a better lens to be approved in the US. Very occasionally I'd have momentary blur when the brain seemed to be confused I guess over which eye to pay attention to. Obviously ideally its best to play it safe and have good vision in both eyes. In addition even with 20/20 vision in good lighting, the cataract can cause poorer vision in dimmer lighting in addition to glare, etc.
The issue if you wait due to having one good eye is of course to carefully watch for problems in the good eye and be prepared to act quickly if your vision degrades in your other eye, or if you stop being able to tune out the bad eye for any reason. I hadn't realized that might happen and hadn't expected this, but eventually when the bad eye got worse I had trouble tuning it out. I had thought it would just suppress the bad eye's image indefinitely so I'm not sure what it was, whether perhaps once the image got too color-shifted/blurry the brain had trouble realizing they were both the same image (in which case it would just take the better image and ignore the other) and was confused thinking they were two different images and not being sure which to use, or what explained the difficulty.
Thank you very much for your feedback doctor...Will no capsule, will I be able to achieve 20/20 vision with the IOL?or is it reduced vision as compared to a lens placed in the capsule?
I already have some posterior vitreous detachment - not sure if it related to the cataract..it happened one year after the cataract was diagnosed..Does this complicate the surgery further?
Are chances of retina detachment more with no capsule and vitrectomy?
Are you in the USA doctor? Can i I get your name if you are?
I already have some posterior vitreous detachment - not sure if it related to the cataract..it happened one year after the cataract was diagnosed..Does this complicate the surgery further?
Are chances of retina detachment more with no capsule and vitrectomy?
Are you in the USA doctor? Can i I get your name if you are?
hello
The pinhole made the vision better so I am not sure whats happening there
I was diagnosed with the cataracts in 2013 so its been close to 2 years now.
The other eye is affected as well - just glares but 20/20 vision. How long can I wait for the eye that is 20/80?
What is the percentage of complications for this types of caratact - Capsule rupture..I was told the opacity is 5 mm.
Thanks!
The pinhole made the vision better so I am not sure whats happening there
I was diagnosed with the cataracts in 2013 so its been close to 2 years now.
The other eye is affected as well - just glares but 20/20 vision. How long can I wait for the eye that is 20/80?
What is the percentage of complications for this types of caratact - Capsule rupture..I was told the opacity is 5 mm.
Thanks!
Posterior polar cataracts are exactly that-small opacities right at the center of the posterior part of your crystalline/natural lens.
Many people with such cataracts actually find that pinholes magnify the effect of the cataract, because it forces the light to go through the opacity. So it could increase the amount of glare/halos. In fact most people with such cataracts see better in the dark as their pupils dilate (provided there are no headlights shining into their eyes...).
20/80 to 20/50 is not a particularly significant change.
The timing of surgery depends very much on yourself and how your vision is affecting your daily life. As a doctor, I would say your level of vision qualifies you for surgery already, but how long you wait is mostly up to you. Posterior polar cataracts do become more difficult/risky to do as the nucleus hardens, but you are only 35, and this process could take some time to occur.
Many people with such cataracts actually find that pinholes magnify the effect of the cataract, because it forces the light to go through the opacity. So it could increase the amount of glare/halos. In fact most people with such cataracts see better in the dark as their pupils dilate (provided there are no headlights shining into their eyes...).
20/80 to 20/50 is not a particularly significant change.
The timing of surgery depends very much on yourself and how your vision is affecting your daily life. As a doctor, I would say your level of vision qualifies you for surgery already, but how long you wait is mostly up to you. Posterior polar cataracts do become more difficult/risky to do as the nucleus hardens, but you are only 35, and this process could take some time to occur.
Hi
Thanks for your detailed reply...20/80 was without the pinhole,,,with the pinhole it was 20/50.
yes, I meant I have some refractive error because I as able to read better with the pinhole.
and you may be correct that I may not see better with the glasses..since glare has been a big issue with Polar cataract but I was hoping that atleast for indoor computer use, the glasses will help.
Of course, I want to avoid surgery as long as possible unless the doctor insists on it due to other complications.
Thanks for your detailed reply...20/80 was without the pinhole,,,with the pinhole it was 20/50.
yes, I meant I have some refractive error because I as able to read better with the pinhole.
and you may be correct that I may not see better with the glasses..since glare has been a big issue with Polar cataract but I was hoping that atleast for indoor computer use, the glasses will help.
Of course, I want to avoid surgery as long as possible unless the doctor insists on it due to other complications.
If you have better vision with the pinhole then then there is a decent chance that contacts or glasses should be able to help. I am guessing that the "20/80" refers to your "best corrected visual acuity" (likely gotten from the pinhole test if you didn't get a refraction done) which means that they can't completely restore good vision. I will note the caveat that vision issues can sometimes cause irregular distortions that aren't easily correctible with a lens though, so it is likely you can get an improvement, though it isn't guaranteed.
The odds are regular glasses could help, though in the unlikely case they didn't, worst case there are actually "pinhole glasses" which are essentially plastic filled with pinholes, I hadn't researched them to know how well they work, but merely noticed their existence recently.
By saying "I also have some refraction." I assume you mean "some refractive error", i.e. astigmatism (since thats the topic of your post), myopia, or hyperhopia.
Cataracts often cause increased refractive error (or changed refractive error, some become less farsighted for instance), and seem the more likely explanation than anything non-visual related (especially since only one eye is having problems). While usually they take years to do so, it can happen fast in some cases, and it sounds more likely among those who have cataracts younger than is typical. When my problem nuclear cataract arose in one eye when I was 49, the eye showed a major increase in astigmatism from -0.75D to -4D within about 3.5 months, decreasing best corrected acuity from 20/25 to 20/60. Around 2.5 years later, the last check before surgery, it was back to not much astigmatism, but far more myopic, shifting from around -9.5D to -19D. My other eye showed some early signs of cataract but was 20/20 correctible when I had surgery on both eyes in December. Oddly that eye had gotten a bit less myopic due to the early cataract.
The odds are regular glasses could help, though in the unlikely case they didn't, worst case there are actually "pinhole glasses" which are essentially plastic filled with pinholes, I hadn't researched them to know how well they work, but merely noticed their existence recently.
By saying "I also have some refraction." I assume you mean "some refractive error", i.e. astigmatism (since thats the topic of your post), myopia, or hyperhopia.
Cataracts often cause increased refractive error (or changed refractive error, some become less farsighted for instance), and seem the more likely explanation than anything non-visual related (especially since only one eye is having problems). While usually they take years to do so, it can happen fast in some cases, and it sounds more likely among those who have cataracts younger than is typical. When my problem nuclear cataract arose in one eye when I was 49, the eye showed a major increase in astigmatism from -0.75D to -4D within about 3.5 months, decreasing best corrected acuity from 20/25 to 20/60. Around 2.5 years later, the last check before surgery, it was back to not much astigmatism, but far more myopic, shifting from around -9.5D to -19D. My other eye showed some early signs of cataract but was 20/20 correctible when I had surgery on both eyes in December. Oddly that eye had gotten a bit less myopic due to the early cataract.
Have an Answer?
You are reading content posted in the Eye Care Community
Top General Health Answerers
Kansas City, MO
Grand Prairie, TX
San Diego, CA
Discharge often isn't normal, and could mean an infection or an STD.
In this unique and fascinating report from Missouri Medicine, world-renowned expert Dr. Raymond Moody examines what really happens when we almost die.
Think a loved one may be experiencing hearing loss? Here are five warning signs to watch for.
When it comes to your health, timing is everything
We’ve got a crash course on metabolism basics.
Learn what you can do to avoid ski injury and other common winter sports injury.
For a normal cataract, the risk of PCR in my hands is about 1%, for a posterior polar it is higher, possibly 10-20%, because there are some posterior polar cataracts where the opacities are stuck to the posterior capsule and there is no way to remove the cataract without causing a break in the capsule.
What is important is that the surgeon is experienced enough to handle the PCR. I would not worry about the PCR as such-it is unavoidable in many cases of posterior polar cataract. If the surgeon handles the PCR in a proper manner and avoids the loss of vitreous or manages the vitreous well, then the results are essentially the same as if no PCR happened.
Technically, in posterior polar cases, here are the important things, if you are interested.
1. Hydrodelineate, not hydrodissect
2. Remove the nucleus first-a soft nucleus is much easier to remove in such circumstances
3. Remove the epinucleus and cortex-PCR may or may not occur at this stage
4. If PCR occurs-Viscoat to plug the gap, while keeping the anterior chamber pressurized
5. If gap small, no vitreous loss, IOL placed in bag. Result is as if no PCR occurred
6. If gap big, lens goes in with haptics in sulcus and optic capture by the rhexis. Result is pretty much as above
7. If vitreous loss then that needs to be carefully removed with vitreous cutter
Only thing is surgery could take longer to complete. Bottom line is, a good doctor should be able to handle a PCR and a posterior polar cataract. It is not usually a very difficult thing to do as long as the proper precautions are taken and the technique modified accordingly.