後嚢破損－予防、認識、管理－レビュー

We prefer using posterior capsular rent is a significant intraoperative complication of cataract surgery, often leading to vision-threatening sequelae if not promptly recognized and appropriately managed. PCR can result from various factors, weak zonules, posterior polar cataracts, including improper phacoemulsification techniques, and excessive instrument manipulation. Early recognition is critical, and swept-source optical coherence tomography and intraoperative assessments can enhance early detection. Prevention strategies focus on meticulous surgical planning, careful hydrodissection, judicious use of phaco power, and maintaining anterior chamber (AC) stability. Techniques such as slow-motion phacoemulsification, femtosecond laser-assisted cataract surgery (FLACS), and capsule-stabilizing devices can reduce the risk of PCR in high-risk cases. Once a rupture occurs, prompt and careful management is essential to prevent further complications such as vitreous loss, retained lens fragments, or intraocular lens (IOL) malposition. Anterior vitrectomy using bimanual or coaxial techniques is crucial for clearing vitreous from the AC and preventing traction on the retina. The choice of IOL implantation depends on the extent of PCR, with options including sulcus-fixated, iris-fixated, scleral-fixated, or ACIOLs when capsular support is inadequate. Postoperative management includes monitoring for cystoid macular edema, retinal detachment, and endophthalmitis, which are more common following PCR. This review underscores the importance of surgical vigilance, adherence to best practices, and an individualized approach to optimizing the visual outcomes following this challenging complication.