Cataract Extraction Requiring Vitrectomy due to Violation of the Posterior Capsule with Lens Implantation (Optic Capture, in the Bag, Sulcus, and ACIOL)

Abstract

In performing routine or complex phacoemulsification (i.e., pupil-dilating devices, capsular staining, zonulopathy requiring capsular tension rings/segments with suturing, iris/scleral sutured IOL), the reader is advised to refer to the appropriate chapters in this textbook. One of the challenges during cataract surgery is dealing with the vitreous gel when it presents itself intraoperatively. Given that the scope of vitreous and lens management cannot be covered in any great detail within one single operative template, this chapter focuses on essential surgical steps one needs to take in managing intraoperative complications when the posterior capsule (PC) is violated (Table 23.1). The farther vitreous travels from the vitreal cavity (categories 1–3, Table 23.1), the greater the traction on the vitreous base with increased risk for a retinal tear or detachment (Arbisser et al., Ophthalmol Clin N Am 19:495-506, 2006; Arbisser, Suppl Cataract Refract Surg Today, 2012). The concepts have been simplified to familiarize the reader in dealing with vitreous. A number of references are provided for further in-depth reading to surgically build upon the basic outline provided in this chapter (Arbisser et al., Ophthalmol Clin N Am 19:495-506, 2006; Arbisser, Suppl Cataract Refract Surg Today 2012; Oetting, http://www.eyerounds.org/tutorials/anterior-vitrectomy/index.htm; Kent, Rev Ophthalmol, 2009).

Table 23.1 Classification