Intraoperative management of posterior capsule tears in phacoemulsification and intraocular lens implantation

Objective: This paper presents the incidence, causes, and management of pos terior capsule (PC) tears and their postoperative outcomes in a large serie s of eyes that underwent cataract removal and intraocular lens (IOL) implan tation, operated on by one surgeon. Design: Retrospective, noncomparative case series. Participants: Eighteen thousand four hundred seventy consecutive eyes (1992 -1999) were reviewed with the assistance of electronic medical records for incidence of PC tears in patients seeking treatment at an outpatient catara ct surgery clinic. Intervention: Eyes in this series underwent continuous curvilinear capsulor rhexis (CCC), nucleofractis phacoemulsification, and IOL implantation under topical anesthesia. Different intraoperative surgical strategies such as p osterior continuous curvilinear capsulorrhexis (PCCC) were used in the mana gement of PC tears. Main Outcome Measures: Routine preoperative and postoperative visual and re fractive outcomes were recorded, including incidence of lens capsule tears, IOL position, and postoperative complications. Results: Posterior capsule tears occurred in 83 of 18,470 eyes, resulting i n an overall incidence of 0.45%. Of these 83 eyes with PC tears, 49% receiv ed vitrectomy. Fifty-one of 83 PC tears (61.4%) were amenable to be convert ed to PCCC. Of these 51 procedures, 50 eyes had PC IOL in-the-bag fixation. One eye had PCCC with optic capture. There were no eyes with dropped nucle i or nuclear fragments requiring pars plana vitrectomy. Seventeen eyes (20. 5%) had Neuhann anterior capsule rhexis fixation with the haptics placed in the sulcus and IOL securely in the bag. Ten eyes (12.1%) had the IOL place d in the sulcus, and 5 eyes (6.0%) required anterior chamber IOL fixation. None of the 83 PC tears resulted in clinically evident cystoid macular edem a, retinal detachment, or endophthalmitis. Conclusions: With an intact CCC and with conversion of PC tears to PCCC, in -the-bag fixation of IOLs can be achieved in most eyes. (C) 2001 by the Ame rican Academy of Ophthalmology.