1219: posterior polar capsule rupture

This patient has bilateral posterior polar cataracts which progressively became more opaque and caused increasing visual problems. The first eye had a successful cataract surgery with a resident surgeon including placement of a toric IOL to address the pre-existing corneal astigmatism. That video can be found here:

This eye from the same patient proved to be a bigger challenge. The posterior capsule splits during cataract removal and there is some vitreous prolapse. The challenge is that we wanted to implant a toric IOL to address the corneal astigmatism. Now what?

Some surgeons advocate doing a reverse optic capture of the single-piece acrylic toric IOL with the haptics behind the anterior capsulorhexis and the optic brought in front of it. This can work but we may worry about long term stability since our patient is so young (about 30). We elected to implant a three-piece monofocal non-toric IOL with the haptics in the sulcus and the optic captured behind the anterior capsulorhexis. In choosing the IOL power, we must first understand the calculations and take into account the differences in the A-constant of the different IOLs. That is all explained in this post:

We elected to perform astigmatic keratotomy incisions at the end of the case to address the corneal astigmatism and we were able to reduce it to just about 0.5 D residual cylinder. There is some great learning in this case and I trust that it will help you in your future posterior polar cases.

click to learn from this complicated posterior polar cataract case: