This is a retrospective, interventional case series, assessing the occurrence of anterior capsular tears in phacoemulsification surgery, its effect on outcomes and further complications. Despite being a well recognised complication of phacoemulsification surgery the authors felt that there is a lack of large scale evidence on the consequences of anterior capsular tears, which this study sought to rectify. To ensure that the results are realistic and reflect day-to-day practice, they used figures from a training setting, with surgeons of variable grades and experience. Exclusion criteria were previous trauma or eye surgery, planned ECCE and combined procedures. The study group comprised of 239 eyes that suffered anterior capsular tears and the control group 212 consecutive eyes that had undergone uncomplicated phacoemulsification. The main outcome measures were intraoperative complication rates, postoperative refraction and vision and the incidence of short-term (resolving within eight weeks) complications, such as macular oedema, prolonged post-op uveitis and transient ocular hypertension. The results in the study group showed a 2% rate to ECCE conversion, 24% concurrent posterior capsular rupture and 5% of dropped nucleus into the vitreous. Eleven percent (27 eyes) required a second surgical procedure, of which 10 eyes required removal of dislocated lens material from the vitreous, 11 eyes required correction of primary aphakia, five eyes required IOL repositioning or exchange and one eye required macula-off, rhegmatogenous retinal detachment repair. Seventy-one percent of eyes had a significant visual improvement and the refractive outcome was poor in 22.4% (>1 diopter off target). Just 1.7% developed permanent visual loss due to corneal decompensation, chronic cystoid macular oedema and macula-off retinal detachment. In this series, the surgeon’s grade and expertise did not seem to play any statistically significant role in increasing the associated intra -/ postoperative complications. The authors emphasise the importance of modifying the surgical technique in order to ensure safe completion of surgery with the best possible visual outcome. They also recommend that a single-piece IOL could be safely implanted in the bag, when adequate capsular conditions are present.

Complications and outcomes of phacoemulsifiction cataract surgery complicated by anterior capsule tear.
Carifi G, Miller MH, Pitsas C, et al.
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Efrosini Papagiannuli

Birmingham and Midland Eye Centre, Birmingham, UK

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