Incision capsular bag herniation during subluxated lens surgery: mechanisms, management, and prevention

Area of Science:

• Ophthalmology
• Surgical Complications
• Cataract Surgery

Background:

• Incision capsular bag herniation (ICBH) is a rare complication during cataract surgery, particularly in eyes with pre-existing lens subluxation.
• Understanding the mechanisms and predisposing factors of ICBH is crucial for effective management and prevention.

Purpose of the Study:

• To investigate the mechanism, intraoperative characteristics, management, and prevention of incision capsular bag herniation (ICBH).
• To analyze this previously unreported complication in eyes with lens subluxation undergoing cataract surgery.

Main Methods:

• A retrospective observational case series of five patients who developed ICBH during phacoemulsification with intraocular lens (IOL) implantation.
• Analysis of clinical data to identify predisposing factors, intraoperative triggers, and outcomes.
• Evaluation of a stepwise intraoperative management protocol including IOP reduction and capsular decompression.

Main Results:

• The estimated incidence of ICBH was 0.58% among 867 subluxated-lens surgeries.
• ICBH was associated with zonular dialysis, elevated IOP, and sudden decompression, often triggered by instrument insertion or withdrawal.
• The stepwise management protocol resulted in successful capsular repositioning and in-the-bag IOL implantation in all cases, with significant visual acuity improvement.

Conclusions:

• ICBH arises from a combination of zonular weakness, surgical factors, and intraocular pressure fluctuations.
• A structured intraoperative management strategy can lead to favorable outcomes.
• Prevention strategies should focus on thorough pre-operative assessment and meticulous surgical technique.