Surgeon: Noting signs and risk factors of capsular rupture can prevent occurrence

WAIKOLOA, Hawaii — Capsular rupture is a common complication that surgeons can prevent with knowledge of risk factors and early signs, a surgeon said here.

"Capsular rupture is probably one of the most common serious complications encountered during cataract or refractive lens exchange surgery," David R. Hardten, MD, said during Hawaiian Eye 2008.

The reported rate of capsular rupture is estimated between 0.05% to 10%, according to Dr. Hardten.

Capsular rupture can precipitate other problems or procedures, he said, such as cystoid macular edema, inflammation, retinal detachment, inadequate capsular support leading to IOL dislocation and the need for a vitrectomy.

"However, if handled appropriately and well, most of the time capsular rupture will not create these other complications," Dr. Hardten said. Furthermore, identifying a tear early can prevent enlargement.

"The most important pearl is that if you feel that the capsule has ruptured, it probably has. It is important to identify it and accept that it has happened in order to achieve a better outcome," he added.

Dr. Hardten urged surgeons to be "extra observant" of risk factors such as posterior polar cataracts, trauma, prior vitrectomy, asteroid hyalosis, poor visualization or a small pupil.

"A small pupil can lead to a small capsulorrhexis. Surgeons used to maneuvering in the periphery might pull on the anterior capsule, dislocate the zonules and create a capsular tear," he said.

In addition, a deeper or shallower anterior chamber should be considered a risk factor.

"If the chamber is either deeper or shallower than usual, there may be higher risk of losing vitreous and tearing the capsule," Dr. Hardten said.

Dr. Hardten suggested that surgeons exercise caution during capsular polishing, irrigation and aspiration, early- to mid-phacoemulsification, and toward the end of phacoemulsification, when the last pieces of nucleus are emulsified.

He said, "That is when the capsule is moving up and down quite a bit. Surgeons should monitor fluid flow at that point and watch the wound to ensure that the capsule is not coming up into contact with the wound."

"Sudden deepening of the anterior chamber and momentary pupillary dilation from the deepening of the anterior chamber are also signs of early capsular rupture," Dr. Hardten said. "Always be on the lookout for signs, especially in higher risk cases."