Review: Be Careful if you see the Hole Punch Sign

In your first 1000 cataract surgeries, the most common cause of a posterior capsule rupture is iatrogenic damage from the phaco probe or second instrument. In particular, it takes time to learn how close the phaco tip is to the posterior capsule, particularly when the view is blocked by cataract material. If you see the Hole Punch Sign in any of the nuclear pieces during phaco, you must assume that the posterior capsule has been violated.

In the case presented here, a novice surgeon is being supervised by a more experienced surgeon. This is an anonymous video submission and I am neither the surgeon nor the supervising ophthalmologist. The original video was more than 1 hour in length, so we have edited it down to about 14 minutes. There are great teaching points in this video.

The two surgeons do a good job of recovering from this complication and an anterior vitrectomy is performed and eventually insertion of a three-piece acrylic IOL into the sulcus with optic capture. I’m told that the patient recovered good vision (20/25) at the post-op 1 week visit. Thank you for sharing so that we all may learn from your case. We encourage other readers to also submit anonymous cases for the benefit of the group.

Click the pic below to learn from this important teaching video: