Surgical outcome following breach rhexis

Phacoemulsification cataract surgery is the gold standard for lens removal and continuous curvilinear capsulorhexis is one of the important first steps during the procedure. It is also one of the most difficult steps to master and so has a learning curve and capsulorhexis breach is therefore common among trainees. Once there is capsulorhexis breach, the surgeon could continue with the procedure or convert to extracapsular extraction, with each having its advantages and disadvantages. In our unit, the phacoemulsification procedure is usually continued with some modifications, and the results over a specified period are presented. To report the incidence of breach rhexis during phacoemulsification over a specific period, deduce reasons for the breach, as well as the surgical outcome including other intraoperative and postoperative complications directly resulting from the capsular tear. Interventional case series.

All patients who developed breach rhexis during routine phacoemulsification had all information regarding the procedure entered into a predesigned ProForma. These ranged from the instruments used for the capsulorhexis to subsequent surgical modification to reduce risk of further complications to the final surgical outcome.

In the study period March 12, 2004, to March 30, 2005, the team carried out 358 phacoemulsifications, of which 20 (0.56%) had breach rhexis. The end of the breach was visible in 70% of cases and equatorial in the rest. None extended to the posterior capsule and so there was no vitreous loss in any of these cases. In most of the cases, the cause of the breach was attributed to inexperience or error of judgment (60%). However, modification of the surgery including the transfer of the procedure to a more experienced surgeon helped to reduce the rate of further complications. Eighty-five percent of the patients achieved a corrected visual acuity of 6/12 or better and those with worse vision had comorbidity.

In this study, the authors showed that, when properly managed, capsular breach during phacoemulsification has little or no effect on the final surgical outcome.