Complications from a Failed Capsulorhexis

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There is a great deal of learning from this video where a failed capsulorhexis leads to a host of issues including an open posterior capsule. Miraculously, there is no vitreous prolapse and the single-piece IOL is still placed within the capsular bag with good stability. Now, more than 2 months after this patient’s surgery, the tissues have healed and the IOL is, in fact, very secure and still within the capsular bag. How did things go downhill so fast?

The primary issue is that a novice surgeon pulled the anterior capsular flap in a linear manner instead of a circular one. This caused an immediate radialization of the anterior capsular tear out to the zonules. The remainder of the anterior capsule was opened using the can-opener technique. This is important so that there are many areas of the anterior capsular rim to absorb capsular stress during cataract removal. If we have just the one radialized area then all capsular forces are directed that way and this tear can extend around the equator and to the posterior capsule.

The case goes relatively well, all things considered, until we go to remove the viscoelastic. The novice surgeon goes behind the IOL optic and causes stress which allows the capsule tear to extend to the posterior capsule, which splits completely down the middle. Fortunately, we have the IOL haptics oriented away from this split and thus the IOL is held securely in position. With care, there is no vitreous prolapse.

This video is a must-see for young or novice surgeons. There is a tremendous amount of learning to be had.

click below to learn from this critically important case:

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

3 Comments

  1. When I’m dealing with a surgical complication I always remember the words of Charles Kelman:”as a surgeon is better to be lucky than good” 🙂

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