If there is a central posterior capsule plaque that cannot be removed with the suction from the irrigation/aspiration probe, we can sometimes perform a posterior capsulorhexis. This will remove the opacity and prevent the need for a future YAG laser capsulotomy.
This technique is more easily performed in younger patients because they tend to have a more solid vitreous with an intact anterior hyaloid face. This patient is between 50 and 60 years old and the technique works well. The empty capsular bag is filled with our cohesive viscoelastic and then a cystotome is used to puncture the posterior capsular. Next a small amount of dispersive viscoelastic is injected into this opening to create a barrier between the backside of the posterior capsule and the anterior hyaloid face. Our forceps are then used to create the capsulorhexis which is round and continuous with a diameter sufficient to remove the opacity.
In this patient the anterior capsulorhexis is 5 mm in diameter while the posterior capsulorhexis is 3 mm in diameter. The IOL is then placed carefully in the capsular bag with care taken to avoid placing the IOL through the posterior capsular opening. Finally, we remove the viscoelastic from the anterior chamber but we do not go behind the IOL optic. This surgery was performed by one of my senior residents who has done about 250 to 300 cataracts so far.
Click below to learn the technique of posterior capsulorhexis: