title: Complications and outcomes of phacoemulsification cataract surgery complicated by anterior capsule tear.
abstract: OBJECTIVE
  To study the results of phacoemulsification cataract surgery complicated by anterior capsule tear.
  
  
  METHODS
  Retrospective interventional controlled case series.
  
  
  METHODS
  Consecutive series of eyes suffering intraoperative anterior capsule tear and others with uneventful cataract surgery at Moorfields Eye Hospital were investigated. Biometric, intraoperative, and postoperative details were recorded. The exclusion criteria were combined surgical procedures, planned manual extracapsular cataract extraction, and history of previous intraocular surgery or eye trauma. The main outcome measures were intraoperative capsule complication rates, refractive and visual outcomes, and incidence of short-term postoperative complications. Two-sided Fisher exact and paired t tests were used for categorical and continuous data, respectively.
  
  
  RESULTS
  The study and control groups included 239 and 212 eyes, respectively. In the study group, planned phacoemulsification was converted to manual extraction in 5 cases (2%); a concurrent posterior capsule rupture occurred in 58 eyes (24%) with a rate of nuclear lens material drop in the posterior segment of 5% (11 cases). Over 11% of eyes (n = 27) underwent unplanned secondary surgical procedures. Overall, the refractive outcomes were poor in 22.4% of eyes (postoperative refraction ≥1 diopter of target), and were statistically worse (P < .0001). A significant visual improvement was observed in the majority of the study group eyes (71%); permanent visual loss occurred in 4 eyes (1.7%).
  
  
  CONCLUSIONS
  Anterior capsule tear can lead to additional intraoperative complications, with a relatively high incidence of secondary interventions. Overall, permanent visual loss can be observed and worse refractive outcomes are to be expected, particularly if the lens is being implanted out of the bag.
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom. Electronic address: gianlucacarifi@gmail.com.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Carifi
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Miller
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Christos
authors.initials: C
authors.lastname: Pitsas
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Zygoura
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Rajesh R
authors.initials: RR
authors.lastname: Deshmukh
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kopsachilis
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Maurino
mesh_terms: D057971:Anterior Capsular Rupture, Ocular / Q000209:etiology*; D001699:Biometry; D005128:Eye Diseases / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D018918:Phacoemulsification / Q000009:adverse effects*; D011183:Postoperative Complications; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology