A ruptured posterior capsule is a complication that can happen in any cataract surgery. There are two types of ophthalmologists who do not have surgical complications: (1) those who don’t actually operate, and (2) those who are not fully truthful. Think of it like driving a car: even if you are a fantastic driver and you are super careful, over the course of driving for many decades, you will end up in at least one minor accident or fender bender. That’s life.
The same applies to cataract surgery. The rate of posterior capsule rupture varies among surgeons and it also relates to the amount of surgical experience. During residency, studies have shown a typical capsule rupture rate of about 6% and that can be even higher if the surgeon has done fewer than 100 cataract surgeries. For highly experienced surgeons who have done more than 10,000 cataract surgeries, there is still a risk of posterior capsule rupture even if it is significantly less than 1%.
When we encounter a posterior capsule rupture, the keys to management are: recognize, react, recover, and refer. We need to recognize the moment when the posterior capsule is ruptured and that is captured in the picture shown here. Now we must react appropriately which means accepting that a complication has occurred, keeping the anterior chamber pressurized, and taking measures to remove the remaining cataract pieces and prevent further vitreous prolapse. To recover from the complication, we need to remove the lens material, perform an anterior vitrectomy, and securely place the IOL. Finally, we need to refer this patient to a vitreo-retinal colleague for a pars plana vitrectomy and pars plana lensectomy to remove the retained lens fragments. By following these keys, the patient can achieve excellent vision despite having the complication. And look at the bright side: this patient will never need a YAG laser capsulotomy!
click to learn from this case of a ruptured posterior capsule: