POSTERIOR CAPSULAR RUPTURE DURING CATARACT SURGERY: WHEN DOES IT OCCUR?

Although posterior capsular rupture (PCR) occurs in only 0.91% of cataract surgeries conducted within the NHS, they are associated with a higher risk of vision-threatening complications such as macular oedema, retinal detachment and endophthalmitis. The main aim of this study was to describe the pre- and intra-operative features of cataract surgery cases with PCR, with or without associated anterior capsular (AC) tears.

Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom

This retrospective observational cohort study included cataract surgery cases conducted in Moorfields NHS Foundation Trust that developed PCR, between January 2014 and December 2018. The primary outcome measure was the stage of cataract surgery in which the PCR occurred. The secondary outcome measures were incidence of other intraoperative complications (AC tears, vitreous loss, zonular dialysis and dropped nucleus) and the location of intraocular lens (IOL) implantation.

1042 eyes were included in the study and PCR occurred at the following stages: hydrodissection in 40 (3%) eyes, phacoemsulsification in 619(60%) eyes, irrigation-aspiration (IA) in 248 (24%) eyes, lens implantation in  87(8%) eyes, viscoelastic removal in 44(4%) eyes and wound hydration in 2 (1%) eyes. 624/1042(60%) eyes had a sulcus lens, 117/1042(11%) lens in the bag, 190/1042(19%) sulcus optic capture, 24/1042(2%) AC lens and 87/1042(8%) aphakic. 835/1042 (80%) eyes had vitreous loss, 123/1042 (12%) eyes had dropped nucleus and 47/1042 (5%) eyes had zonular dialysis. 15% of PCR cases were associated with an AC tear. In the group with AC tears, PCR occurred during hydrodissection or phacoemulsification in 80% of eyes compared to 61% of eyes in the non-AC tear group (p<0.05). In the AC tear group, the IOL was implanted within the bag in only 4.5% of eyes compared to 12.4% of eyes in the non-AC tear group (p<0.05). In the AC tear group, 23% of eyes were left aphakic or with an anterior chamber lens compared to 9% of eyes in the non-AC tear group (p<0.05).

PCR is most likely to occur during the phacoemulsification stage of cataract surgery. Surgeons should be aware that the presence AC tears may increase the risk of PCR during the earlier stages of surgery, such as hydrodissection and phacoemulsification. It may also necessitate IOL implantation in alternative locations to the capsular bag or even leaving the patient aphakic.