Coincidental Intra-Operative Posterior Capsular Tear And Intra-Ocular Lens Damage: Lessons Learnt

The purpose of this unique case report is to explain the science involved in managing simultaneous intraoperative damage to the posterior lens capsule and the implanted IOL.

A tertiary eye hospital. A surgical case report

A surgical case report. 

A 67-year-old male underwent an uneventful coaxial microphacoemulsification. During the I/A process, a sub-incisional PC tear occurred. After a careful anterior vitrectomy, the surgeon attempted to implant a 1-piece foldable IOL carefully into the capsular bag, taking care not to get the PC rent extended. After insertion of the IOL, surprisingly, the terminal 1/3^rd of the distal haptic was fractured and retained in the injector system. The leading haptic was dialed out of the bag into the AC to facilitate IOL dissection and explantation.

As the IOL with a partially deficient haptic seemed to center well in the AC, the surgeon re-dialed the IOL into the bag with haptics 90 degrees away from the line of PCR, to be relieved of the stressful circumstance. IOL centered well within the bag post-operatively.

1-piece IOLs with stable-force haptics exhibit maximal stretch at the equator of the capsular bag with an overall diameter of 11-12 mm, which is proximal to the terminal third of the haptic. Hence, IOL with a fractured (damaged) distal third of the haptic need not be explanted and remains well centered within the bag without postoperative consequences.