Complicated posterior capsulorhexis: aetiology, management, and outcome

A 1 year retrospective analysis of 650 patients, who underwent a posterior capsulorhexis on their intact capsules, was performed to examine the incidence of complications, their aetiologies, and the outcome.

Data were analysed on 32 patients with complicated capsulorhexis for type of surgery, preoperative and postoperative factors, and relative risk factors for vitreous issue.

There were six patients with vitreous loss. The posterior capsulorhexis was uncontrolled in 14 cases and difficult to perform in 12 cases. Implantation into the capsular bag was possible in all cases. Systemic vascular hazard and old age (over 80 years) were found to be statistically significant risk factors for vitreous loss (p = 0.002 and p = 0.03 respectively). The mean follow up was 13.5 months (range 4-25 months). One patient developed a retinal detachment and two had a transient clinical cystoid macular oedema. Visual acuity of > or = 20/40 was obtained in 93% of the patients.

Loss of control of the posterior capsulorhexis has a low incidence but can lead to serious problems during surgery. A good knowledge of the technique is necessary to complete the procedure with a posterior capsulorhexis of the optimum size without vitreous loss.