Wait! Is the Posterior Capsule Ruptured?

is posterior capsule ruptured 159 title

In this video which was submitted anonymously, the guest surgeon had a routine case with an intact capsulorhexis. But then when the lens was inserted and the viscoelastic removed, something happened. There are lines visible in the central posterior capsule and there is another line noted in the superior part of the view. What’s going on?

Watch the video carefully and see if you can figure out what’s going on. Don’t read any further if you want to play long with the quiz. Watch the video first.

What happened is a focal loss of zonular support in the superior area — that is that line seen near the limbus. It is the capsular bag equator in that meridian. The two large lines in the central posterior capsule are wrinkles of the capsule. The loss of zonular support has allowed floppiness in the posterior capsule so the two wrinkles appear.

What is the best course of action now? There are a few options:

  • We can leave everything as-is and just finish the case. This is what the surgeon does in this case.
  • We can rotate the IOL so that the one haptic helps support the area of zonular loss. The risk here is that the haptics may get caught up in the capsule and cause further damage.
  • We can insert a capsular tension ring to help support the area of zonular loss. The capsular bag would first need to be inflated with more viscoelastic.

Click below and watch carefully. Can you determine what the problem is and when it happened?

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

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