Posterior capsular disruption during cataract extraction

Purpose. Posterior capsular disruption with or without vitreous loss is one of the most common complications encountered by the cataract surgeon. The purpose of this study is to determine the incidence of this complication, its long term effect on visual acuity and the safety of inserting an intraocular lens. Methods. We retrospectively reviewed the records of 2245 consecutive eyes that had undergone extracapsular cataract extraction between January 1981 and December 1990, to review cases of posterior capsular disruption with or without vitreous loss. Data were collected and included: the stage at which the disruption occurred, the behavior of the vitreous, type of intraocular lens implanted, intraopcrative and postoperative complications. Results. The overall incidence of a torn posterior capsule was 3.2% (71 cases). Vitreous loss occurred in 47 of these eyes (66.2%). Out of 71 eyes with capsular disruption, 65 cases occurred during cortical cleanup, four cases occurred during nucleus expression and two cases occurred during capsular polishing. Postenor chamber intraocular lenses were implanted in 47 cases (66.2%), anterior chamber intraocular lenses in 21 cases (29.6%), and in three cases (4.2%), no implant was used. Final visual acuity of 20/40 or better was achieved in 49 (69%) of these cases. Postoperative complications included: pupillary block (one eye), opacification of the posterior capsule (four eyes). cystoid macular edema (eleven eyes), and phaco-anaphylaxis (one eye). Conclusion. Our study indicated that intraocular lens implantation in the face of posterior capsular disruption is well tolerated by most patients and vitreous loss is not a contraindication to intraocular lens implantation. Despite the infrequent complications of the torn posterior capsule, a good visual result can be achieved in most patients.