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Speaker shares pearls for managing ruptured capsule during cataract surgery
KIAWAH ISLAND, S.C. — The incidence of capsule rupture and anterior vitrectomy during cataract surgery is significant, estimated at up to 5% of cases, according to a speaker here.
To prevent capsular rupture, the surgeon's goal should be to reduce acute intraoperative traction that results from a variety of manipulations as well as prevent posterior dislocation of the lens, Steve Charles, MD, told colleagues at Kiawah Eye 2011.
Once the capsule ruptures, Dr. Charles said viscoelastics can be injected to protect the capsular defect. Then, to retrieve the lens material after the viscoelastic barrier is in place, the surgeon should lower the bottle and use low-flow phacoemulsification.
Viscoelastic can be used to reposition lens material, Dr. Charles said, and phaco probes and loops can be used to remove it.
"Bear this in mind, if you had a penetrating keratoplasty, and you dropped a piece of jagged black nucleus through the hole, it won't hurt the retina. ... Lens material won't hurt the retina ever in anybody. So it isn't the end of the world to drop lens material in the back of the eye. It is bad news to pull on the vitreous and make a giant break," Dr. Charles said.
Dr. Charles' pearls for preventing retinal tears included:
- Never put the phaco probe into the vitreous.
- Never irrigate lens material with a water jet.
- Never use a lens loop to manipulate material in the back of the eye; rather, remove the vitreous first.
"We take all the vitreous out first before we do anything with the lens. ... IOLs and lens material never once hurt anybody," he said.
- Disclosure: Dr. Charles receives consulting fees from Alcon Laboratories.