title: Intraoperative management of posterior capsule tears in phacoemulsification and intraocular lens implantation.
abstract: OBJECTIVE
  This paper presents the incidence, causes, and management of posterior capsule (PC) tears and their postoperative outcomes in a large series of eyes that underwent cataract removal and intraocular lens (IOL) implantation, operated on by one surgeon.
  
  
  METHODS
  Retrospective, noncomparative case series.
  
  
  METHODS
  Eighteen thousand four hundred seventy consecutive eyes (1992-1999) were reviewed with the assistance of electronic medical records for incidence of PC tears in patients seeking treatment at an outpatient cataract surgery clinic.
  
  
  METHODS
  Eyes in this series underwent continuous curvilinear capsulorrhexis (CCC), nucleofractis phacoemulsification, and IOL implantation under topical anesthesia. Different intraoperative surgical strategies such as posterior continuous curvilinear capsulorrhexis (PCCC) were used in the management of PC tears.
  
  
  METHODS
  Routine preoperative and postoperative visual and refractive outcomes were recorded, including incidence of lens capsule tears, IOL position, and postoperative complications.
  
  
  RESULTS
  Posterior capsule tears occurred in 83 of 18,470 eyes, resulting in an overall incidence of 0.45%. Of these 83 eyes with PC tears, 49% received vitrectomy. Fifty-one of 83 PC tears (61.4%) were amenable to be converted to PCCC. Of these 51 procedures, 50 eyes had PC IOL in-the-bag fixation. One eye had PCCC with optic capture. There were no eyes with dropped nuclei or nuclear fragments requiring pars plana vitrectomy. Seventeen eyes (20.5%) had Neuhann anterior capsule rhexis fixation with the haptics placed in the sulcus and IOL securely in the bag. Ten eyes (12.1%) had the IOL placed in the sulcus, and 5 eyes (6.0%) required anterior chamber IOL fixation. None of the 83 PC tears resulted in clinically evident cystoid macular edema, retinal detachment, or endophthalmitis.
  
  
  CONCLUSIONS
  With an intact CCC and with conversion of PC tears to PCCC, in-the-bag fixation of IOLs can be achieved in most eyes.
authors.affiliation: Gimbel Eye Centre, 4935 40th Avenue NW, Suite 450, Calgary, Alberta, Canada T3A 2N1. hvgimbel@gimbel.com
authors.forename: H V
authors.initials: HV
authors.lastname: Gimbel
authors.forename: R
authors.initials: R
authors.lastname: Sun
authors.forename: M
authors.initials: M
authors.lastname: Ferensowicz
authors.forename: E
authors.initials: E
authors.lastname: Anderson Penno
authors.forename: A
authors.initials: A
authors.lastname: Kamal
mesh_terms: D000416:Alberta / Q000453:epidemiology; D019923:Capsulorhexis; D005131:Eye Injuries / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000601:surgery*; D007903:Lens Capsule, Crystalline / Q000293:injuries* / Q000601:surgery; D019654:Lens Implantation, Intraocular / Q000009:adverse effects*; D018918:Phacoemulsification / Q000009:adverse effects*; D012029:Refraction, Ocular; D012189:Retrospective Studies; D012421:Rupture; D014792:Visual Acuity