Unexpected posterior capsule rupture with unfolding silicone plate-haptic lenses

To evaluate the incidence, management, and long-term outcomes of unexpected posterior capsule rupture during injection of a C11UB plate-haptic silicone intraocular lens (IOL) with the Passport II system (both Bausch & Lomb Surgical).

Tertiary referral center and teaching hospital.

This retrospective analysis comprised 24 cases of posterior capsule rupture during plate-haptic silicone IOL injection.

Over 6 months, a C11UB IOL was injected after phacoemulsification in 3446 cases, from which 24 patients were drawn. Thus, the rate of posterior capsule rupture was 0.70%. The median preoperative best corrected visual acuity was 6/48 (range 6/12 to light perception). The median best spectacle-corrected acuity at the time of discharge or the last visit was 6/9 (range 6/4 to 6/24). Twenty patients had improved acuity, 2 lost 1 Snellen line, and 2 had unchanged acuity. There were no postoperative complications in 13 patients (54%). Three patients required further surgery. Twenty-one patients were discharged after a mean of 32 weeks +/- 22 (SD); they required a mean of 5 +/- 4 visits. The remaining 3 continue to be followed because of their preoperative ocular comorbidity.

Although no predisposing factor was identified, we believe the risk for posterior capsule rupture during IOL injection can be minimized by careful injection technique. In particular, if there is doubt about the integrity of the zonules, anterior capsule, or posterior capsule, a plate-haptic silicone IOL should not be injected. With the appropriate management, the final visual outcome was good.