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

ABSTRACT

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.