Incidence and functional outcome of phacoemulsification complicated by posterior capsular rupture

To evaluate retrospectively anatomic and functional results of phacoemulsification with posterior chamber intraocular lens implantation, complicated by intraoperative posterior capsular rupture (PCR).

Data were gathered from medical records of 930 patients (one thousand eyes), who underwent phacoemulsification. The examined group consisted of 52 eyes of 52 patients, 27 women (52%), and 25 men (48%), 50 to 84 years old (mean age 73.52 +/- 7.8), who underwent phacoemulsification complicated by intraoperative posterior capsular rupture. The control group consisted of 427 patients, including 263 women (61.59%) and 164 men (38.41%), at the age 44 to 93 (mean age 70.3 +/- 10.2), who underwent uncomplicated cataract phacoemulsification. All patients had ophthalmic examination preoperatively, one day postoperatively and 10 to 14 days postoperatively. The evaluated data included: patients' age and gender, pre- and postoperative best corrected visual acuity, intraocular pressure, state of the anterior and posterior segment, early postoperative complications, type of implanted intraocular lens and whether anterior vitrectomy was performed. Nonparametric tests were used for statistical analysis (Wilcoxon signed-ranks test and Mann-Whitney U test).

A statistically significant difference in postoperative BCVA between both groups was found. Mean postoperative BCVA in the PCR group was 0.63 +/- 0.27, whereas mean postoperative BCVA in the reference group was 0.78 +/- 0.18 (p < 0.001). Ten patients in the PCR group (19%), required anterior vitrectomy. In-the-bag implantation was performed in all eyes from the reference group, but it constituted only 31% (16 eyes), of the PCR group. We found that eyes with PCR are 2.6 times more likely to develop other intraoperative complications and early postoperative complications in comparison with controls. In our study eyes with PCR were about 5 times more likely to have a final BCVA worse than 0.5 than eyes from uncomplicated surgery group.

Eyes with intraoperative PCR during phacoemulsification have a higher risk of reduced BCVA, however, it is possible to achieve good final BCVA in the majority of eyes. Appropriate intraoperative and postoperative management will usually allow to perform a successful procedure with safe placement of an intraocular lens, thus ensuring a relatively favourable outcome.