Management of posterior capsule tears

Any breach in the continuity of the posterior capsule is defined as a poste rior capsule tear. Posterior capsule tears can be preexisting (congenital o r traumatic), spontaneous, or intrasurgical. Preexisting/congenital posteri or capsule tears have been related to an intrauterine insult. Posterior cap sule tears due to trauma may occur as a consequence of direct mechanical im pact due to perforation or blunt injury. Depending on the duration of time between the posterior capsular trauma and the cataract surgery, these poste rior capsule tears can have different features. Intrasurgical posterior cap sule tears are the most common and can occur during any stage of cataract s urgery. Also, they may be planned in the form of primary posterior capsulor hexis. The conventional management consists of prevention of mixture of cor tical matter with vitreous, dry aspiration, and anterior vitrectomy, if req uired. In addition, during phacoemulsification low flow rate, high vacuum, and low ultrasound are advocated if a posterior capsule tear occurs. Disloc ated nucleus or nuclear fragments require vitrectomy and the use of perfluo rocarbon liquids. In the presence of a posterior capsule tear, the IOL can be placed ill the sulcus, if the capsular rim is available, or in the bag, if the tear is small. Scleral fixated posterior chamber lenses and anterior chamber IOLs can be implanted when the posterior capsule tear is large. (S urv Ophthalmol 45:473-488. 2001. (C) 2001 by Elsevier Science Inc. hll righ ts reserved.).