Posterior Capsule Rupture During Cataract Surgery

Posterior Capsule Rupture During Cataract Surgery

Posterior Capsule Rupture During Cataract Surgery

 

 

Posterior capsule rupture-anatomy of the eyeThe natural crystal clear lens is completely surrounded by an elastic transparent membrane called the capsule and this capsule is attached by fibrous strands called zonules or suspensory ligaments which connect the lens and the capsule to the ciliary body.

Infront of the lens and capsule lies the iris with the pupil in the center and the anterior chamber which is space filles with clear fluid called aqueous humor. Behind the capsule lies the vitreous body.

During cataract eye surgery, the eye doctor creates a hole or an opening in the front surface of the capsule in order to remove the natural lens (the cataract). After removal of cataract the inside of the capsule is empty like a bag and the eye doctor will insert the artificial intraocular lens inside this bag.

Sometimes the back surface of the capsule is ruptured accidentally during cataract surgery and the vitreous which lies behind the capsule starts to move towards the anterior chamber.

 

 

Posterior capsule rupture during cataract surgery can increase the incidence of retinal detachment during and after the surgery because the vitreous is attached to the retina and when the vitreous moves forward to the anterior chamber, it can pull the retina with it, leading to retinal tears or holes which if not treated early by laser photocoagulation it can cause retinal detachment.

Sometimes,through this hole or tear in the back surface of the capsule, small pieces of cataract can drop to the back of the eye towards the vitreous and retina and most of the time,these pieces should be removed with another type of surgery called pars plana vitrectomy in which the surgeon will make small incisions in the eye to have access to the vitreous.

Posterior capsule rupture during cataract surgery is treated by remove all the vitreous from the anterior chamber and the capsular bag with anterior vitrectomy and removal of the cataract pieces that were dropped to the back of the eye and the Intraocular Lens can be implanted either in the capsular bag, the sulcus (space between the front surface of the capsular bag and the back surface of the Iris) or in the anterior chamber.

 

 

Choosing between the capsular bag, the sulcus and the anterior chamber for intraocular lens Implantation depends mainly on the size of the rupture of the capsule.  If the size is small, IOL (Intraocular lens) can be implanted in the capsular bag. If the rupture is large and it involves only the back surface of the back, the IOL can be implanted in the Sulcus.

Sometimes, the rupture is very large and it involves both the back surface of the bag and the front surface of the bag and in this case the IOL should be implanted in the anterior chamber.

 

Anterior Chamber Intraocular Lens implantation in patient who had Posterior Capsule Rupture during Cataract Surgery

 

The intraocular lens is implanted infront of the iris. A new way of IOL implantation is called scleral fixation of Intraocular lens, in which the IOL will be implanted in the posterior chamber and it will be fixed in this position either by suturing the haptics of the Intraocular lens with the sclera or sutureless glued intraocular lens implantation implantation with intrascleral fixation

 

 

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