Managing a shallow capsular bag during cataract surgery requires delicate technique and strategic planning to avoid complications such as zonular stress or posterior capsule rupture. The first priority is to maintain adequate anterior chamber depth during phaco by increasing the infusion pressure. In cases of compromised zonules or pseudoexfoliation, capsule stabilization devices such as capsular tension rings (CTR) may be necessary. During phacoemulsification, low flow and vacuum settings with controlled aspiration help minimize turbulence and posterior capsule mobility. The nucleus should be mobilized centrally and emulsified in the safe zone away from the posterior capsule. The chopper can be used the help protect the posterior capsule from coming in contact with the phaco probe tip. Intraocular lens (IOL) implantation should be performed slowly and under OVD protection. Throughout the case, constant attention to chamber stability and gentle handling are essential for safety.
It always seems like raising the IOP (bottle height) should help push the posterior capsule posteriorly, but in my experience it usually doesn’t work that way. When the issue is BSS movement into Berger’s space, it seems to me that higher infusion pressure in going to either have no effect (if pressures are equal anterior and posterior) or perhaps even compound the problem (if it drives even more fluid posteriorly). I haven’t yet found a good way to counteract the problem, just need to proceed carefully as you described.
Agree. Great points. Higher infusion pressure ends up pushing more fluid through the zonular gaps into Berger’s space. Thanks for the comment.