3069: the capsule is wide open – now what?
This case had a critical iatrogenic complication: during enlargement of the main clear corneal incision, a shallow anterior chamber allowed the sharp keratome blade to pass directly across the anterior chamber and puncture the posterior capsule. Enlarging an incision without first fully inflating the anterior chamber with cohesive viscoelastic drastically reduces working space and removes the protective space between the blade and the delicate capsular bag. Once the posterior capsule is wide open, the surgeon must immediately halt all aspiration, maintain chamber stability with viscoelastic before withdrawing instruments, perform a thorough anterior vitrectomy with triamcinolone staining, and pivot to sulcus placement with optic capture or secondary IOL fixation.
Watch the video to see how this wide-open posterior capsule rupture was managed and how to structure your intraoperative sequence to prevent keratome-induced capsule damage. What is your standard procedure for ensuring adequate chamber depth before introducing sharp instrumentation to enlarge incisions? Please comment your thoughts below.
