Zonular Apparatus Capsular Bag Insufficiency with Spontaneous Posterior Capsule Rupture

Area of Science:

• Ophthalmology
• Surgical Complications
• Cataract Surgery Outcomes

Background:

• Zonular apparatus capsular bag (ZACB) insufficiency can lead to late intraocular lens (IOL) dislocation post-cataract surgery.
• Spontaneous posterior capsule rupture (SPCR) with IOL dislocation is a rare but significant complication.

Purpose of the Study:

• To report and discuss the clinical features and outcomes of ZACB insufficiency presenting with SPCR.
• To identify potential contributing factors and patient demographics associated with this complication.

Main Methods:

• Retrospective review of 7 SPCR cases post-cataract surgery (March 2021 - February 2025).
• Analysis of clinical records and surgical videos for patient data, IOL status, and surgical outcomes.
• Classification of capsular rupture stage and IOL dislocation based on intraoperative findings.

Main Results:

• Most SPCR cases (5/7) had intact anterior capsule rims and intact zonules, with IOLs fixated in the sulcus.
• Two cases involved both anterior and posterior capsule dislocation, requiring intrascleral IOL fixation.
• The average patient age was 52 years, with 5 patients having atopic dermatitis. Time since initial surgery averaged 13.8 years.

Conclusions:

• Atopic dermatitis is frequently associated with SPCR cases.
• Minor trauma may contribute to ZACB insufficiency.
• Capsule morphology was generally preserved, except for the posterior capsule rupture itself.