Posterior Capsule Rupture & Anterior Vitrectomy

ruptured post capsule title

Early in the learning curve of cataract surgery, beginning surgeons end up with a posterior capsule rupture about 5% of the time. This tends to decrease for most surgeons to a level that is very low, usually less than 1%, and for some experts, even lower than that. But we must all know how to manage a posterior capsule rupture and this case is a great example.

This surgery was done by one of my resident surgeons with me supervising and assisting him during the case. The capsulorhexis radializes and then during hydro-dissection there is the dreaded snap sign as described by my friend Ronald Yeoh MD 20 years ago. As soon as this happens, I know that the posterior capsule is wide open, undoubtedly extended from the radialized area. To avoid the entire nucleus from falling into the vitreous, it must be brought up into the anterior chamber before placing the phaco probe in the eye. The infusion pressure of the phaco probe could push the entire nucleus into the vitreous, necessitating a full pars plana vitrectomy and lensectomy like in this case.

I use the chopper and a cannula to divide the nucleus into two halves, like shown in this video, which are then brought up into the anterior chamber. More dispersive viscoelastic is injected behind the nucleus to support it and provide a barrier to prevent the vitreous from prolapsing. Next these nuclear pieces are phaco-emulsified safely. The bimanual 23g vitrectomy is used to remove the lens cortex as well as perform the anterior vitrectomy.

  • For cortex removal use “I/A Cut” mode
    • foot position 1: irrigation
    • foot position 2: aspiration
    • foot position 3: activate cutter
  • For vitreous removal use “Anterior Vitrectomy” mode
    • foot position 1: irrigation
    • foot position 2: activate cutter
    • foot position 3: aspiration

Triamcinolone is used to stain the vitreous to ensure that a complete anterior vitrectomy is completed and that no strands are in the anterior segment. As an extra measure of safety, a small peripheral iridotomy is made with the vitrector. The three-piece lens is then placed into the ciliary sulcus and the incision is sutured for security.

This patient had more inflammation in the post-op period and some initial corneal edema, but healed well within a month. The patient achieved excellent vision and was very thankful for her results. The resident learned a lot and this case helped hone surgical judgment which will help countless patients in the future.

Click below for the video of Posterior Capsule Rupture with Anterior Vitrectomy:

All content is © 2018 by Uday Devgan MD. All rights reserved.

 

 

3 Comments

  1. How do we count our capsular complication rate. I mean , invariably we have to take up cases which have preexisting zonular weakness/ intumescent cat/ hypermature/ those with PXF/ PPCs / Brown cataracts. Do rents in these add up to our capsular complication rate. Of course there are those which are perfectly fine to start with n we end up having PCR .

    Sorry for the off topic question .

    Thanks again for all the efforts in the continuing education 🙏🙏

  2. Hi sir I hope your days good can please write your parameters in IA/cut frequently I suffer from AC collapse and the parameters of cut/IA thanks dear

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