posterior chamber deepens with capsule break

When the posterior chamber deepens during cataract surgery, it is usually a sign that the posterior capsule has been ruptured. This allows nuclear pieces to sink back into the anterior vitreous and we notice the extra deep posterior chamber. This is the time to stop (without withdrawing infusion from the eye) and add more viscoelastic via the paracentesis incision.

This case ends up with vitreous prolapse into the anterior segment which then needs to be cleaned up. There is are small retained nuclear fragments in the vitreous and we do not attempt to fish for these. Instead the anterior segment is cleaned up, a suclus IOL is secured, and the incision is sutured closed. The patient then underwent a pars plana vitrectomy with a retina specialist colleague. The outcome was good vision for the patient.

Click to learn this critical danger sign and how to finish the case:


  1. Uday, can you comment on the phenomenon of the chamber deepening excessively during irrigation without capsule rupture when either the phaco probe or the AI probe is inserted. This happened to me recently in an elderly woman with Parkinson’s in both eyes. When I say deep, I was worried the posterior capsule would touch the macula! There was no prior history of vitrectomy and she wasn’t a high myope. I assume she had very weak zonules. I dealt with it by subluxing the lens into the ac and decreasing the IOP and aspiration settings (with more viscoat of course).

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