Hypersonic vitrectomy in intraoperative posterior capsular rupture with retained nuclear fragments

In our report, we present the hypersonic vitrectomy (Vitesse, Bausch and Lomb) being employed for anterior vitreous liquefaction and removal in posterior capsular rupture. The capsular tear with nucleus drop during conventional phacoemulsification was managed by vitrectomy using the hypersonic vitrector after posterior-assisted levitation followed by intraocular lens (IOL) implantation. The minimal cortical and epinuclear lens particles in the anterior chamber and vitreous were also liquefied with a stoke length of 30 to 40 ?m and aspirated via the Vitesse vitrectomy system. The same probe performs the vitrectomy and the nucleus removal. The postoperative period was uneventful with clear cornea, normal fundus, and 20/20 best-corrected visual acuity (BCVA). The hypersonic vitrectomy utilizes the ultrasound power of 29.5 kHz and a stoke length of 0 to 60 ?m for liquefaction of the vitreous. It can be a safe alternative for vitrectomy and lens removal in a single setting.

Analysis on risk factors and prognosis of posterior capsular rupture in phacoemulsification cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract?AIM: To investigate the risk factors and prognosis of posterior capsular rupture in phacoemulsification cataract surgery through analyzing the cataract patients in our hospital.?METHODS:Totally 1825 patients (1912 eyes) treated in our hospital were selected from November 2012 to November 2015. The patients with posterior capsular rupture were as observation group.Control group was randomly selected with a 1: 4 ratio in patients without posterior capsular rupture.All the patient's age, gender, type of cataract, ocular disease history, other medical history, surgical history, preoperative intraocular pressure, the eyes affected, the health situation, visual acuity at 1d before and after surgery and other factors were recorded and analyzed for risk factors and prognosis.?RESULTS: Statistical results showed gender, type of cataract, preoperative intraocular pressure, history of tobacco and alcohol, eyes affected and other factors did not impact on the rupture rate ( P>0.05 ); and type of nucleus, preoperative visual acuity, some eye diseases were the risk factors for posterior capsule rupture ( P<0.05).Postoperative visual acuity of the two groups was all improved, but visual acuity of patients with posterior capsule rupture significantly decreased.?CONCLUSION: With eye disease history ( a history of vitreous hemorrhage, retinal detachment before surgery and preoperative visual acuity <20/200) are more likely to result in intraoperative posterior capsular rupture.Nuclear hardness over grade Ⅳ is also an important risk factor. Before one surgery, it is needed to learn more about the medical history of cataract patients, to conduct a reasonable comprehensive assessment for risk factors, to decrease the risk in the surgery, which are to increase the success rate and to improve the prognosis.

Clinical analysis of posterior capsular rupture in small incision non -phacoemulsification cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To analyze the cause of posterior capsular rupture in small incision non - phacoemulsification cataract surgery and investigate the treatment methods. METHODS: The clinical data of 108 cases ( 121 eyes ) undergone small incision non - phacoemulsification cataract surgery combined with intraocular lenses ( IOL) implantation were retrospectively analyzed. The causes of posterior capsular rupture and treatment of 6 patients (6 eyes) after surgery were analyzed and summarized. RESULTS: Six cases ( 6 eyes, 4. 96%) occurred posterior capsular rupture during the operation, of which 2 cases ( 2 eyes ) underwent posterior chamber IOL implantation intraoperative, 2 cases (2 eyes) receivedIIstage IOL implantation in the ciliary sulcus at 1wk postoperative, 2 cases ( 2 eyes ) were given anterior chamber IOL implantation. One case ( 1 eye ) whose vision acuity CONCLUSION:Posterior capsular rupture which occurs in different stages of the operation is the commonest intraoperative complication in small lincision non -phacoemulsification cataract surgery. With improving operative techniques, and continuously accumulating experience, incidence of posterior capsular rupture can be effectively reduced. Even posterior capsular rupture occurs intraoperative, patients can still get a good outcome after timely and proper treatment.

Clinical application of posterior continuous curvilinear capsulorhexis of posterior capsular rupture in the phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract? AlM: To observe the clinical effect of posterior continuous curvilinear capsulorhexis ( PCCC ) in phacoemulsification with posterior capsular rupture.?METHODS: Thrity-eight age-related cataract patients (38 eyes) from March 2013 to October 2013 were selected as experimental group and 50 age - related cataract patients ( 50 eyes ) from March 2013 to October 2013 as control group. ln experimental group, PCCC were used in the intraoperative posterior capsule tears in phacoemulsification. And in control group phacoemulsification was applied. The visual acuity and surgical complications were compared between two groups, the follow-up period was continued to 3mo after operation.?RESULTS: The visual acuity and corneal edema in two groups had statistically significant ( P 0. 05 ). At 1d after operation, the intraocular pressure in two groups was not statistically significant (P>0. 05). Three months after operation, the pupil and cystoid macular edema, retinal detachment in two groups was not statistically significant (P>0. 05).?CONCLUSlON:PCCC can improve the therapeutic effect and prevent surgical complications for phacoemulsification with posterior capsular rupture.

Choice of One-Piece Intraocular Lens Power and Changes of Anterior Chamber in Sulcus Implantation due to Posterior Capsular Rupture during Cataract Surgery

PURPOSE: To evaluate the appropriate correction of predicted intraocular lens (IOL) power when sulcus implantation due to posterior capsular rupture was performed and to compare the anterior chamber angle of sulcus-implanted eyes with in-the-bag implanted eyes using anterior segment optical coherence tomography (Visante OCT). METHODS: Fifty-two eyes of 52 patients who had IOL implantation in the sulcus due to posterior capsular rupture during cataract surgery were retrospectively reviewed. A 0.5 lower diopter IOL than predicted IOL power using SRK-T formula was chosen. The difference between the predicted refractive error and the spherical equivalence at the 3-month time-point after sulcus implantation were evaluated. Among 52 patients, 16 patients whose fellow eye had an in-the-bag IOL implantation underwent Visante OCT and the anterior angle of affected eyes and normal fellow eyes were compared. RESULTS: The difference between the predicted refractive error using SRK-T formula and the spherical equivalence after sulcus implantation was a myopic shift of 0.597 +/- 0.879 diopter. The mean iridocorneal angles, angle opening distance (AOD), trabecular iris surface area (TISA) at 500 um and 750 um for both nasal and temporal sides in sulcus implantation were all significantly lower than in-the-bag implantation. CONCLUSIONS: A choice of a 0.5 lower diopter power IOL than the power for in-the-bag implantation may be considered because of greater myopic shift than predicted refractive error when sulcus implantation due to posterior rupture is performed. Anterior chamber angle in sulcus IOL implantation was shallower than in-the-bag IOL implantation.

Analysis of Cause and Outcome of Posterior Capsular Rupture during Phacoemulsification in Cataract Surgery

PURPOSE: This study is to evaluate the time, cause, management and consequences of the posterior capsule rupture during cataract extraction using phacoemulsification. METHODS: We retrospectively reviewed the medical records of 30 eyes of 30 patients who had undergone posterior capsule rupture during cataract operation with phacoemulsification from February 1997 to February 2000. RESULTS: The rupture occurred most frequently during the phacoemulsification (46.7%) and irrigation and aspiration procedure (36.7%). The capsule-ruptured patients' preoperative conditions were small pupil (30.0%), lack of cooperation (10.0%) and high vitreous pressure (6.7%). But no specific reason was found in half of the cases; probably surgeon's incomplete technique was the cause. We performed anterior vitrectomy in 66.7% of all cases. All cases were started as phacoemulsification, with 4 cases (13.3%) requiring conversion to extracapsular cataract extraction. Intraocular lenses were implanted in the sulcus (53.3%) and in the bag (33.3%). Final corrected visual acuity of 0.5 or better was achieved in 83.3% and 0.8 or better was in 63.3%. Final visual acuity of 0.1 or worse was occurred in 2 cases (6.7%) and the reasons were corneal edema due to endothelial cell damage and postoperative intraocular pressure elevation, respectively. CONCLUSIONS: When properly managed, a torn posterior capsule can result in an excellent visual outcome. Preoperative and intraoperative management such as more frequent administration of mydriatics, use of iris retractors and retrobulbar anesthesia are most important to prevent the posterior capsule rupture.

Risk Factors for Posterior Capsular Rupture in Cataract Surgery

PURPOSE: The purpose of this study was to evaluate the risk factors for posterior capsular rupture in cataract surgery (phacoemulsification or ECCE). METHODS: The charts of patients who had cataract surgery between March 1993 and May 2000 were reviewed retrospectively. Probable risk factors included age, sex, operated eye (right or left), type of surgery, preoperative visual acuity, presence of diabetes mellitus, diabetic retinopathy, hypertension, glaucoma, corneal disease, type of cataract, history of posterior capsular rupture in the other eye (if operated), axial length of the eye, and anterior chamber depth. We compared 63 patients who had posterior capsular rupture with 65 randomly selected patients who had no complications, using statistical analysis. RESULTS: The type of surgery (p<0.0005), presence of diabetic retinopathy (p<0.05) and type of cataract (p<0.05) were significant risk factors. The others were not statistically significant with posterior capsular rupture in cataract surgery. CONCLUSIONS: Patients with risk factors for posterior capsular rupture such as diabetic retinopathy, mature and mixed cataract should be carefully operated by experienced surgeons.

Clinical Results of The Eyes with Posterior Capsule Rupture During Cataract Operation

To evaluate the character, management and clinical results of the posterior capsular rupture during cataract surgery, we retrospectively studied the cataract surgeries that were performed between May 1989 and April 1998. We discovered 194 eyes in which the posterior capsule was torn. The overall incidence of this complication was 3.15%. Our chart review of these surgical procedure revealed that the tear occurred most frequently during the nucleus removal(63.9%), occurred more frequently at the periphery than the center and the extent was mostly below one-third of the whole posterior capsular surface(75.8%). We performed vitrectomy(58.8%) and peripheral iridectomy(8.8%). Posterior capsular lenses were implanted in 183 cases. The predicted power of lens calculated with SRK-II formula and manufacturer`s A-constant was approximately 0.46 diopter less than actual postoperative refraction. Final visual acuity of 20/40 or better was achieved in 76.8% of the 194 cases. Our results revealed that when properly managed, a torn posterior capsule is compatible with an excellent visual outcome.

Anatomical Barrier for Anterior and Posterior Capsular Tear Extension

We examined the anatomical barrier for both anterior capsular tear extension and posterior capsular rupture extension which are the most serious intraoperative complications during cataract surgery, using 28 human eyes obtained postmortem. An experimental radial tear, about 1.0 mm in size, was created on the 5.0 mm capsulorhexis margin in the 1st group(7 eyes). Lens nucleus was removed mechanically with hydrodissection and viscoexpression technique. Radial tear extension did not extend over the lens equator in six eyes, and in one eye stopped in front of Wieger's ligament. In the 2nd group(7 eyes), after making zonular rupture around 90 degrees, same procedures were performed. Radial tear extension stopped at the equator in four eyes, and in three eyes stopped in front of Wiegel's ligament. In the 3rd group(7 eyes), we performed capsulorhexis and routine phacoemulsification for lens nucleus and cortex removal. Then we created only a posterior capsule rupture with intact anterior hyaloid membrane and vitreous pressure was increased. Posterior capsular rupture extension stopped in front of Wieger's ligament in all seven eyes. In the 4th group(7 eyes), after creating the rupture of the posterior capsule including anterior hyaloid membrane, intraocular lens was inserted into the empty capsular bag as a perpendicular direction to the axis of the tear. Posterior capsular rupture extension passed Wieger's ligament in only one eye, but did not reach equator or anterior capsule. In this study, we found that zonules, equator portion of the capsular bag and Wieger's ligament act as anatomical barriers for anterior capsular teal extension as well as for posterior capsular rupture extension.