Tough Cataract Surgery: Ruptured Capsule, Anterior Vitrectomy, Sulcus IOL, Great Outcome

The learning curve for cataract surgery is steep and ophthalmologists need many years to achieve a level of expertise that can rescue them from most tough situations. This case is performed with a resident surgeon in the last year of training and it is done with the supervision of a professor level surgeon. The primary error is excessive hydro-dissection in the setting of a small capsulorhexis which leads to iris prolapse and a blown-out, ruptured posterior capsule. The idea was good: given the patient's history of Flomax (tamsulosin) use, prolapse the nucleus partially out of the capsular bag. I do this technique quite often, but in order for it to be successful, the capsulorhexis must be sufficiently large, at least 5 mm and preferably 5.5 mm in diameter. Here, we have about a 4 mm capsulorhexis and when the nucleus would not prolapse out of the bag, even more balanced salt solution was injected. This finally did bring the nucleus out of the bag but it also caused the iris to prolapse out of the incision and it ripped open the posterior capsule. The iris was reposited by equalizing the pressure gradient behind and in front of the iris stroma by releasing fluid and viscoelastic. The ruptured posterior capsule was not noted until mid-way into the phacoemulsification of the nucleus. We did not see the "snap sign" that was visible in a similar case that we featured last year. This case is different: (please go to CataractCoach.com to read the full article)

• #education
• #cataract_surgery
• #cataract_coach
• #uday_devgan_md
• #ruptured_capsule
• #posterior_capsule
• #anterior_vitrectomy
• #dropped_nucleus
• #phaco_rescue