Intracapsular Cataract Surgery In Modern Practice: Managing Unexpected Zonular Dehiscence

Although intracapsular cataract extraction (ICCE) was the standard technique in the 1970s–1980s, it has been largely replaced by phacoemulsification. However, ICCE remains indicated in cases of complete zonular loss, lens subluxation/luxation, or intraoperative complications where capsular support is absent. The aim of this report is to describe a case of unexpected total zonular dehiscence requiring ICCE and to highlight key surgical considerations that remain relevant for contemporary surgeons.

Tertiary referral ophthalmology center. Case managed in the cataract surgery unit with vitreoretinal support available when needed.

A 91-year-old female was referred for cataract surgery. Preoperative examination revealed a white cataract without clinical signs of zonular weakness. During phacoemulsification, complete zonular dehiscence was encountered, necessitating conversion to intracapsular cataract extraction in the same surgical session. The nucleus was luxated into the anterior chamber, and a 7 mm corneal incision was made to perform a complete intracapsular extraction. Anterior vitrectomy was carried out to remove prolapsed vitreous and confirm a vitreous-free anterior chamber. A retropupillary Artisan® intraocular lens was then implanted, followed by closure of the corneal wound with 10-0 nylon sutures.

Intracapsular extraction successfully removed the lens nucleus and capsule without further intraoperative complications. Anterior vitrectomy ensured a clear anterior chamber free of vitreous strands. The retropupillary Artisan® intraocular lens was well-centered and stable. Postoperatively, the patient maintained anterior segment stability, with no significant inflammation or elevated intraocular pressure in the immediate follow-up period.

ICCE is rarely performed in the era of phacoemulsification, but it remains a valuable technique when capsular support is absent. Mastering the essentials of ICCE — controlled nucleus luxation, appropriate incision size, careful vitreous management, and secondary lens implantation — allows surgeons to safely manage unexpected zonular catastrophes and optimize outcomes in selected complex cases.