Breaking The Dogma: Posterior Capsule Must Be Intact For A Successful Surgical Outcome In Cataract Surgery?

To break the dogma that the posterior capsule should be intact for a successful surgical outcome, bringing to discussion distinct advantages to performing a posterior capsulorhexis with optic capture in certain situations. Although this technique may seem counter-intuitive, we demonstrate through this case report that this extra surgical step can avoid the serious complications arise from an intraocular lens in the sulcus in cases of discontinuous capsulorhexis, provide a predictable effective lens position, and stabilize the two-chambered eye. Furthermore, this patients can benefit from a clear visual axis for lifetime.

This case report was based on clinical examinations, surgery performed and patient follow-up, held at the Department of Cornea, Medical Sciences University Hospital Eye Institute. 

Male, 48 years old, with a previous history of blunt ocular trauma 4 years ago.The corneal opacity presented was not the main cause of the low visual acuity in this patient,but the cataract that had formed.During the surgery we noticed a discontinuous capsulorhexis 5.5mm in diameter, but the surgery proceeded normally with phacoemulsification and aspiration. Considering that a wider capsulorhexis could imply an instability of the intraocular lens in the bag, besides the fact that we can't get the opacity off the central posterior capsule, we opted for performing a posterior capsulorhexis. So we filled the empty and intacted capsular bag with cohesive viscoelastic.The posterior capsule was punctured centrally and then a dispersive viscoelastic was gently injected through this opening to create a barrier between the backside of the posterior capsule and the anterior hyaloid face.That step helped to lift the posterior capsule away from the anterior hyaloid face and keep that intact.The forceps was then used to create the posterior capsulorhexis which was round and continuous with 4mm diameter.A coesive viscoelastic was placed into the capsule rim and the lens was introduced in a routine manner and position withim the capsule rim. The haptics were extended in the bag and the optic was displaced latelly and depressed to bring it under the posterior capsular edge on each side.A square configuration the posterior capsular axis with optic capture was observed.

The dogma that the posterior capsule should be intact for a successful outcome in cataract surgery is not necessarily true.There are distinct advantages in certain situations to performing a posterior capsulorhexis with or without optic capture: remove dense central posterior capsular plaque which cannot be removed using the irrigation/aspiration probe and avoid the need for future YAG laser and its complications.Furthermore, this surgical step stabilize the two-chambered eye,provides predictable effective lens position and a stable long-term fixation,minimize stray light and achieve the best optical performance.Thus,this technique may be an option to improve outcomes and give patients the benifit from a clear visual axis for lifetime.