Pre-existing posterior capsule breaks from perforating ocular injuries

We analyzed the characteristic features and intraoperative behavior of pre-existing posterior capsule breaks in 12 cases of traumatic cataract caused by perforating ocular trauma. The interval between the occurrence of trauma and cataract surgery ranged from three days to one year. Two distinct types of posterior capsule breaks were found: one had thick, fibrous, opaque margins with associated posterior capsule opacification (type I); the other had thin, transparent margins (type II). Type I breaks did not enlarge intraoperatively, whereas type II breaks behaved as fresh breaks by enlarging during irrigation/aspiration and had to be managed by viscoelastic plugging, dry aspiration, and adequate vitrectomy. Primary posterior capsulectomy was required in all cases with type I breaks because of posterior capsule opacification. The difference in the two types of breaks appeared to be time-dependent: cases with delayed surgical intervention (one month to one year) showed type I breaks with clinical evidence of attempted healing of the defect; cases with early surgical intervention (three days to one week) exhibited type II breaks, which did not differ from fresh intraoperative breaks.