Polishing the capsule and then it splits! Now what?
It’s the moment every surgeon dreads: you’re polishing the posterior capsule for that perfectly clear finish, and suddenly, you see the posterior capsule rupture! Don’t panic because the next 60 seconds will determine the outcome of the case.
In this video, our guest surgeon shows how to salvage the situation by converting the tear into a Posterior Continuous Curvilinear Capsulorhexis (PCCC). By transforming a jagged, unstable hole into a controlled, circular opening, we stop the tear from radiating and preserve the integrity of the bag.
The Golden Rules of PC Recovery:
- Freeze and Fill: The moment you suspect a break, keep your foot in position zero. Use a dispersive OVD to tamponade the vitreous and pressurize the chamber before removing your IA tip.
- Keep it Dry: Avoid hydration of the vitreous. If the anterior hyaloid face is intact, do not use a high-flow irrigation setting.
- The PCCC Maneuver: Use micro-forceps to grasp the edge of the rupture and tear it into a circle, exactly like an anterior rhexis.
- In-the-Bag IOL: With a stable PCCC, you can safely implant a one-piece acrylic IOL in the bag, provided the diameter of the PCCC is smaller than the IOL optic.
Stay calm, control the fluidics, and you can still deliver a 20/20 result.
