gms | German Medical Science

Posterior capsule rupture in cataract surgery most commonly occurs in the stages of quadrant removal and cortex removal, and remains a significant challenge to the surgical outcome. In the case of a posterior polar cataract, the risk of PCR is significantly higher. An intraoperative PCR is considered a relative contraindication to implanting a multifocal IOL. Ultimately, however, the choice between using a multifocal or monofocal IOL, and the approach in the event of a PCR, is evaluated on a case-by-case basis.

A 58-year-old female patient presented with a posterior polar cataract in the left eye, and a visual acuity of 0.05 cc -3.25 Dsph = 0.8. After careful consideration, it was decided to proceed with cataract surgery, and a trifocal IOL was selected for implantation, in order to provide the best possible near and distance vision outcomes for the patient.

Following a successful capsulorhexis, in what was otherwise a routine cataract surgery procedure, the hydrodissection stage was initiated. During the attempt of a partial hydrodissection, a posterior capsule rupture occured, followed by a flattening of the anterior chamber and a prolapse of the iris tissue in the corneal tunnel. The PCR formed vertically, as a near-total rupture, essentially splitting the lens capsule bag into two separate, but loosely connected lateral pockets. A judgement call was then made to proceed with a phacoemulsification and extraction of the nucleus tissue, while not disturbing the cortical tissues, allowing them to secure and act as a bag for the coming IOL implantation. The previously selected trifocal IOL was successfully implanted in the lens capsule and cortical tissue complex, in a similar fashion to the common “in the bag” approach. Following a secure IOL implantation, a pars plana vitrectomy of the left eye was performed, in order to remove the remaining cortical tissue, being mindful to not excessively disturb the pockets of lens capsule tissue.

After the surgery, the patient showed an improvement in the clarity of vision in the left eye, presenting a visual accuity of 1.0 in both near and distance vision in a follow-up visit 6 months later.

This case illustrates a successful outcome and intraoperative management of a surgical procedure of a high risk patient, in which a significant complication had occured. Although posterior capsule rupture in a patient with a posterior polar cataract is fairly common, it is still difficult to predict, requiring vigilance, as well as appropriate surgical approach and precautions.