Recovering from a Hole in the Posterior Capsule

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The posterior capsule is very thin (usually about 4μm) and very delicate and in the course of cataract surgery, it is possible to inadvertently rupture it. In this video, the surgeon ends up briefly contacting the posterior capsule during nucleus removal but it is not noticed until prior to cortex removal. Yet still, it is possible to keep the anterior hyaloid face intact and prevent vitreous prolapse. And we can even safely implant a single-piece acrylic IOL into the capsular bag. Here is how the case evolved (full video below).

Notice how we are able to recover from this case and how the end result is so much better than we saw earlier in a different video where things went downhill fast. The key is identifying the posterior capsule hole as soon as it happens. But as you will see in the video below, things happen very quickly, in a fraction of a second, and that is quite difficult to detect.

One hint that the posterior capsule may have been violated is: seeing a hole through a hemi-nucleus. And that is visible in this case, but just for a second:

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The key then becomes to keep the anterior hyaloid face intact and prevent vitreous prolapse. This is accomplished by injecting dispersive viscoelastic through the posterior capsule and preventing the anterior chamber from collapsing.

Click below to watch the video of this case:

 

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