A DELAYED INTRAOPERATIVE RECOGNITION OF A POSTERIOR CAPSULAR TEAR WITH SUBSEQUENT IMPLANTATION OF THE INTRAOCULAR LENS (IOL) BENEATH THE POSTERIOR CAPSULE AND SUBSEQUENT IOL EXPLANATION

I present a case of a 75 year old patient who underwent a cataract surgery with a delayed recognition of a posterior capsular tear. The patient had early corneal guttate and the procedure was completed using a soft shell technique and phaco chop technique was also adopted to reduced amount of energy used. On attempted removal of the viscoelastic material following removal of the soft lens matter using a coaxial probe, the posterior capsule was being engaged with the probe centrally and it became apparent that the intraocular lens(IOL) was inserted through a central opening of the posterior capsule and was subsequently found to be lying beneath the posterior capsule. The IOL was then explanted with subsequent anterior vitrectomy and a three piece IOL was placed in the sulcus. Postoperatively the patient maintained 6/9 visual acuity. This case highlights the importance of early identification of posterior capsular tears, IOL explantation and secondary sulcus IOL implantation.