ASCRS Clinical Education

ASCRS Focus on Cataract Surgery

Posterior Capsule Rupture

MARCH 2020

Every surgeon can expect a posterior capsule rupture during their surgical career. Prepare for this common complication by reviewing prevention techniques, keys to identification of a tear, and interventional surgical strategies for when a tear occurs.

Explore the surgical videos, expert opinions, and additional resources on posterior capsule rupture provided below to assist in your surgical preparation.

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2019 ASCRS Clinical Survey

Expand each question to the right to view results from the 2019 ASCRS Clinical Survey.

ASCRS Clinical Survey copyright 2019 American Society of Cataract and Refractive Surgery (ASCRS). All rights reserved. No part of this survey may be reproduced without written permission from ASCRS, 4000 Legato Road, Suite 700, Fairfax, VA 22033.

Within the past 12 months, in how many cases have you experienced posterior capsule rupture?

81% of respondents experienced one or more posterior capsule rupture in the last 12 months

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How confident are you in your understanding of phaco machine settings for performing an anterior vitrectomy?

49% of respondents were very confident in their understanding of phaco machine settings for anterior vitrectomy

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Iatrogenic PCR occurs in 1–8% of cataract surgeries, depending on the series. Capsule openings may also precede cataract surgery in the setting of posterior polar cataract or inadvertent capsule puncture during intravitreal injection. Regardless of etiology, cataract surgeons need to know how to manage this problem. Strategies include identifying the tear, limiting its extent, containing or managing forward migration of the vitreous gel, and choosing an appropriate IOL. Stable IOL fixation is often challenging when the capsule or zonules are compromised, but it’s extremely important for good long-term outcomes. Management of PCR is important because of the complications that may follow, which include IOL decentration, axis rotation, iris–lens chafe, retinal tears and detachments, a higher likelihood of endophthalmitis, retained lens particles, dropped nucleus, IOP elevation, and cystoid macular edema. 
Kevin M. Miller, MD

Tackling Posterior Capsule Rupture and IOL Implantation: Video-Based Course

Course Instructors: Amar Agarwal, FRCS; Ashvin Agarwal, MD; Kevin M. Miller, MD; Mitchell P. Weikert, MD, ABO; Eric D. Donnenfeld, MD

The comprehensive, 1.5 hour video-based course will showcase videos on various aspects of inadvertent occurrence of posterior capsule rupture (PCR) during cataract surgery, followed by its effective management. Attendees will be able to effectively handle a case of PCR and perform a posterior capsulorhexis and also will be able to retrieve a sinking nucleus or an IOL followed by its effective placement.

Management of capsule rupture at cataract surgery

Tips for avoiding a retinal break or detachment after cataract surgery

By Steve Charles, MD
This EyeWorld article provides an in-depth look at how to avoid posterior capsule rupture after cataract surgery, including a step-by-step outline for what to do when capsule rupture occurs.

Read this article on >>

JCRS Articles

Explore the latest published research on posterior capsule rupture from ASCRS's premiere publication, the Journal of Cataract and Refractive Surgery.

Nuclear scaffold: Three-dimensional indigenous capsular bag support combined with IOL scaffold and capsular tension ring to prevent posterior capsule rupture in zonulopathy (Dec 2019)

"We describe a technique for performing phacoemulsification in eyes with zonular fiber dehiscence of less than 90 degrees using hard nuclear fragments as a scaffold. In conjunction with a capsular tension ring (CTR), hard nuclear fragments and the intraocular lens (IOL) are used as scaffolds during different steps of nuclear emulsification to prevent posterior capsule rupture and aggravation of zonulopathy...."

Read more on the JCRS website >>

The Risk of Posterior Capsule Rupture during Phacoemulsification Cataract Surgery in Eyes with Previous Intravitreal Anti Vascular Endothelial Growth Factor Injections. (Aug 2019)

"Purpose: To investigate if previous intravitreal anti vascular endothelial growth factor (VEGF) injections are a predictor for posterior capsule rupture (PCR) during phacoemulsification cataract surgery."

Read more on the JCRS website >>

Can preoperative anterior segment optical coherence tomography predict posterior capsule rupture during phacoemulsification in patients with posterior polar cataract? (Dec 2018)

"Purpose: To determine whether preoperative assessment of posterior capsule integrity using anterior segment optical coherence tomography (AS-OCT) can predict posterior capsule dehiscence in patients with posterior polar cataract having phacoemulsification."

Read more on the JCRS website >>

Electron microscopy of silicone irrigation/aspiration tips involved in posterior capsule rupture (Dec 2018)

"We describe 2 cases of posterior capsule rupture caused by Alcon reusable silicone irrigation/aspiration (I/A) tips. Scanning electron microscopy and reflected light microscopy of these tips revealed burring of the inner metallic shafts and tears in the silicone sleeves. A review of surgical video revealed that posterior capsule ruptures caused by the I/A tips occurred when the posterior capsule was aspirated either through the aspiration port or through a tear in the silicone sleeve..."

Read more on the JCRS website >>

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