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Anterior capsule tear in cataract surgery may lead to poor visual, refractive outcomes
Anterior capsule tear during cataract surgery can require additional surgical procedures and may lead to worse refractive outcomes and permanent vision loss, according to a study.
The retrospective interventional controlled case series consisted of 239 study eyes that experienced an intraoperative anterior capsule tear and 212 consecutive uncomplicated phacoemulsification procedures that served as the control group.
In the study group, the observed rate of tear extension to the posterior capsule was 24%, with vitreous loss in 15.9% of eyes and lens material drop in 4.6% of eyes.
Overall refractive outcomes in the study group were poor, with 78.1% of eyes within 1 D of the intended postoperative refraction and only 42.4% within 0.5 D. These outcomes were significantly worse compared with the control group (P < .0001).
Visual acuity of at least logMAR 0.3 was observed in 77% of eyes in the study group compared with more than 93.9% in the control group; the difference was statistically significant (P < .0001). Twelve eyes in the study group lost at least one line of visual acuity.
More than 11% of eyes in the study group underwent unplanned secondary surgeries.
The authors recommended implanting a single-piece IOL in the capsular bag vs. a multi-piece IOL to achieve a final refraction close to the target. – by Kristie L. Kahl
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Once in a while, an article appears that confirms our surgical fears. Cataract surgeons regard posterior capsule rupture as a potentially disastrous complication of cataract surgery but generally do not assign anterior capsular tears similar respect, despite the recognition that a compromised anterior capsulorrhexis, at the very least, compromises the optical result of surgery (22% had a poor refractive result in this series). This large series of 239 cases of anterior capsular tears from the well-respected Moorfields Eye Hospital illustrates a surprisingly high 24% rate of subsequent posterior capsular rupture, with 5% nuclear drop and 11% requiring a secondary repair procedure at a later date. In today’s climate of expectations of flawless surgery and refractive outcomes within 0.25 D, these anterior capsular tear cases definitely significantly adversely affected results. This article serves as a sober reminder to all of us that we should not skimp on the time and effort allotted to achieve a perfect capsulorrhexis, and it should be sized to accommodate IOL capture in case the posterior capsule is compromised later in the procedure. The anterior capsulorrhexis as the life ring of cataract surgery and this article remind us to respect its importance as much as a ship’s captain respects and checks his survival gear before leaving the harbor to venture out.