Timing of posterior capsular rupture during cataract surgery

The main aim of this study was to describe the stage at which posterior capsular rupture (PCR) occurred during cataract surgery and the association with anterior capsular (AC) tears.

This was a retrospective, observational cross-sectional study of all cataract surgeries conducted in Moorfields Eye Hospital complicated by PCR, between January 2014 and December 2018. The primary outcome measure was the stage of cataract surgery in which PCR occurred. The secondary outcome measures were the incidence of AC tears, intraoperative complications and location of intraocular lens (IOL) implantation.

1042 eyes were included in the study and PCR occurred at the following stages: hydrodissection in 40 (3%) eyes, phacoemsulsification in 621 (60%) eyes, irrigation-aspiration (IA) in 248 (24%) eyes, lens implantation in 87(8%) eyes, viscoelastic removal in 44(4%) eyes and wound hydration in 2 (1%) eyes. 624/1042(60%) patients had a sulcus lens, 117/1042(11%) lens in the bag, 190/1042(19%) sulcus optic capture, 24/1042(2%) AC lens and 87/1042(8%) aphakic. 15% of PCR cases were associated with an AC tear. There was a significant difference in the timing of PCR and location of IOL implantation between the eyes with an intact anterior capsulorhexis and those with an AC tear (p < 0.01).

PCR is most likely to occur during the phacoemulsification stage of cataract surgery. However, surgeons should be aware that the presence of AC tears may alter this and possibly influence the location of IOL implantation.