Predisposing Factors for Posterior Capsular Rent

  • Arup Chakrabarti
  • Meena Chakrabarti


The outcome of cataract surgery performed by phacoemulsification in the present scenario is excellent. However, in spite of the recent advances, surgical complications still occur. Posterior capsular rent (PCR), reported to occur in 0.45–5.2 % of cases across all levels of surgical experience, is the most common potential intraoperative complication during cataract surgery [1–11]. It is significant as it may necessitate additional surgical procedures, increased postoperative follow-up needs, and a higher incidence of postoperative complications, which may negatively impact the final visual outcome [1, 12, 13]. However, today, the control rendered through closed chamber modern surgical techniques may allow for a final outcome that is not much different from an uncomplicated case. An improperly managed PCR, with or without vitreous loss, can adversely impact the excellent outcome that is associated with standard cataract surgery. It is desirable to be better prepared for this complication, so that it can be prevented or managed well with better preparedness.


Anterior Chamber Cataract Surgery Posterior Capsule Anterior Chamber Depth Corneal Dystrophy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Narendran N, Jaycock P, Johnston RL, et al. The Cataract National Dataset electronic multicentre audit of 55,567 operations: risk stratification of posterior capsule rupture and vitreous loss. Eye (Lond). 2009;23:31–7. (Pubmed:18327164).CrossRefGoogle Scholar
  2. 2.
    Greenberg PB, Tseng VL, Wu WC, et al. Prevalence and predictors of ocular complications associated with cataract surgery in United States Veterans. Ophthalmology. 2011;118(3):507–14. [Pubmed:21035868].CrossRefPubMedGoogle Scholar
  3. 3.
    Chen M, Lamattina KC, Patrianakos T, Dwarakanathan S. Complication rate of posterior capsule rupture with vitreous loss during phacoemulsification at a Hawaiian cataract surgical centre: a clinical audit. Clin Ophthalmol. 2014;8:375–8.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lundström M, Behndig A, Montan P, et al. Capsule complication during cataract surgery: background, study design, and required additional care. Swedish Capsule Rupture Study Group report 1. J Cataract Refract Surg. 2009;35:1679.e1–87.e1.Google Scholar
  5. 5.
    Tan JHY, Karwatowski WSS. Phacoemulsification cataract surgery and unplanned anterior vitrectomy: is it bad news? Eye. 2002;16:117–20.CrossRefPubMedGoogle Scholar
  6. 6.
    Kothari M, Thomas R, Parikh R, et al. The incidence of vitreous loss and visual outcome in patients undergoing cataract surgery in a teaching hospital. Indian J Ophthalmol. 2003;51:45–52.PubMedGoogle Scholar
  7. 7.
    Wegener M, Alsbirk PH, Højgaard-Olsen K. Outcome of 1000 consecutive clinic- and hospital-based cataract surgeries in a Danish county. J Cataract Refract Surg. 1998;24:1152–60.CrossRefPubMedGoogle Scholar
  8. 8.
    Gimbel HV, Sun R, Ferensowicz M, et al. Intraoperative management of posterior capsule tears in phacoemulsification and intraocular lens implantation. Ophthalmology. 2001;108:2186–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Johnston RL, Taylor H, Smith R, Sparrow JM. The Cataract National Dataset electronic multicentre audit of 55 567 operations: variation in posterior capsule rupture rates between surgeons. Eye. 2010;24:888–93.CrossRefPubMedGoogle Scholar
  10. 10.
    Clark A, Morlet N, Ng JQ, et al. Long-term trends and outcomes of anterior vitrectomy in Western Australia. Acta Ophthalmol. 2015;93(1):27–32.CrossRefPubMedGoogle Scholar
  11. 11.
    De Silva SR, Riaz Y, Evans JR. Phacoemulsification with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract. Cochrane Database Syst Rev. 2014;1:CD008812.Google Scholar
  12. 12.
    Ti SE, Yang YN, Lang SS, Chee SP. A 5-year audit of cataract surgery outcomes after posterior capsule rupture and risk factors affecting visual acuity. Am J Ophthalmol. 2014;157:180.e1–5.e1.CrossRefGoogle Scholar
  13. 13.
    Ionides A, Minassian D, Tuft S. Visual outcome following posterior capsule rupture during cataract surgery. Br J Ophthalmol. 2001;85:222–4.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Berler DK. Intraoperative complications during cataract surgery in the very old. Trans Am Ophthalmol Soc. 2000;98:127–30; discussion 130–132.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Farjo AA, Meyer RF, Farjo QA. Phacoemulsification in eyes with corneal opacification. J Cataract Refract Surg. 2003;29:242–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Hashemi H, Mohammadpour M, Jabbarvand M, et al. Incidence of and risk factors for vitreous loss in resident-performed phacoemulsification surgery. J Cataract Refract Surg. 2013;39:1377–82.CrossRefPubMedGoogle Scholar
  17. 17.
    Hashemi H, Seyedian MA, Mohammadpour M. Small pupil and cataract surgery. Curr Opin Ophthalmol. 2014;26:3–9.CrossRefGoogle Scholar
  18. 18.
    Goldman JM, Karp CL. Adjunct devices for managing challenging cases in cataract surgery: pupil expansion and stabilization of the capsular bag. Curr Opin Ophthalmol. 2007;18:44–51.CrossRefPubMedGoogle Scholar
  19. 19.
    Wilczynski M, Wierzchowski T, Synder A, Omulecki W. Results of phacoemulsification with Malyugin ring in comparison with manual iris stretching with hooks in eyes with narrow pupil. Eur J Ophthalmol. 2013;23:196–201.CrossRefPubMedGoogle Scholar
  20. 20.
    Bell CM, Hatch WV, Fischer HD, et al. Association between tamsulosin and serious ophthalmic adverse events in older men following cataract surgery. JAMA. 2009;301:1991–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Haridas A, Syrimi M, Al-Ahmar B, et al. Intraoperative floppy iris syndrome(IFIS) in patients receiving tamsulosin or doxazosin-a UK-based comparison of incidence and complication rates. Graefes Arch Clin Exp Ophthalmol. 2013;251:1541–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Chang DF. Use of malyugin pupil expansion device for intraoperative floppy iris syndrome: results in 30 consecutive cases. J Cataract Refract Surg. 2008;34:835–41.CrossRefPubMedGoogle Scholar
  23. 23.
    Chang DF, Osher RH, Wang L, Koch DD. Prospective multicenter evaluation of cataract surgery in patients taking tamsulosin (flomax). Ophthalmology. 2007;114:957–64.CrossRefPubMedGoogle Scholar
  24. 24.
    Benjamin L. Cataract surgery in eyes with shallow anterior chamber. In: Chakrabarti A, editor. Cataract surgery in diseased eyes. JAYPEE; 2014. p. 57–60.Google Scholar
  25. 25.
    Chakrabarti A. Phacoemulsification in vitectomozed eyes. In: Chakrabarti A, editor. Cataract surgery in diseased eyes. JAYPEE; 2014. p. 122–31.Google Scholar
  26. 26.
    Osher RH, Yu BC, Koch DD. Posterior polar cataracts: a predisposition to intraoperative posterior capsular rupture. J Cataract Refract Surg. 1990;16:157–62.CrossRefPubMedGoogle Scholar
  27. 27.
    Vasavada A, Singh R. Phacoemulsification in eyes with posterior polar cataract. J Cataract Refract Surg. 1999;25:238–45.CrossRefPubMedGoogle Scholar
  28. 28.
    Crouch Jr ER, Parks MM. Management of posterior lenticonus complicated by unilateral cataract. Am J Ophthalmol. 1978;85:503–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Khalil M, Saheb N. Posterior lenticonus. Ophthalmology. 1984;91:1429–30.CrossRefPubMedGoogle Scholar
  30. 30.
    Brazitikos PD, Tsinopoulos IT, Papadopoulos NT, Fotiadis K, Stangos NT. Ultrasonographic classification and phacoemulsification of white senile cataracts. Ophthalmology. 1999;106:2178–83.CrossRefPubMedGoogle Scholar
  31. 31.
    Drolsum L, Haaskjold E, Sandvig K. Phacoemulsification in eyes with pseudoexfoliation. J Cataract Refract Surg. 1998;24:787–92.CrossRefPubMedGoogle Scholar
  32. 32.
    Max Conway R, et al. Pseudo exfoliation syndrome: pathological manifestations of relevance to intraocular surgery. Clin Exp Ophthalmol. 2004;32:199–210.CrossRefPubMedGoogle Scholar
  33. 33.
    Vajpayee RB, et al. Management of posterior capsule tears. Surv Ophthalmol. 2001;45:473–88.CrossRefPubMedGoogle Scholar
  34. 34.
    Zaidi FH, Corbett MC, Burton BJL, Bloom PA. Raising the benchmark for the 21st century – the 1000 cataract operations audit and survey: outcomes, consultant-supervised training and sourcing NHS choice. Br J Ophthalmol. 2007;91:731–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Najjar DM, Awwad ST. Cataract surgery risk score for residents and beginning surgeons. J Cataract Refract Surg. 2003;29:2035–6.Google Scholar
  36. 36.
    Randleman JB, Wolfe JD, Woodward M, Lynn MJ, Cherwek DH, Srivastava SK. The resident surgeon phacoemulsification learning curve. Arch Ophthalmol. 2007;125:1215–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Rutar T, Porco TC, Naseri A. Risk factors for intraoperative complications in resident-performed phacoemulsification surgery. Ophthalmology. 2009;116:431–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Chandra Bhatta R, Krishniah S, et al. Outcome of the manual small incision cataract surgery at the base hospital and improved surgical eye camps in Nepal: a prospective observational comparative study. J Clin Exp Ophthalmol. 2011;2:9.Google Scholar

Suggested Reading

  1. Buratto L, Packard R. Chapter 22: Richard Packard. In: Buratto L, Osher RH, Masket S, editors. Cataract surgery in complicated cases. Slack Incorporated Thorofare, NJ; 2000. p. 291–350Google Scholar
  2. Michelson MA. Chapter 18: Torn posterior capsule. In: Fishkind WJ et al., editors. Complications in phacoemulsification: avoidance, recognition and management. New York: Thieme Medical publishers; 2002. p. 123–32.Google Scholar
  3. Osher RH, Cionni RJ. Intra operative complications of phacoemulsification surgery: chapter 39; part seven. In: Steinert R et al., editors. Cataract surgery: techniques, complications and management. 2nd ed. Elseiver Science, Philadelphia Pennsylvania; 2004. p. 469–86.Google Scholar
  4. Fishkind WJ. Chapter 31: Posterior capsular tear: avoidance, recognition and management. In: Vajpayee RB, editor. Phacoemulsification surgery. India: Jaypee Brothers Medical Publishers; 2005. p. 237–49.Google Scholar

Copyright information

© Springer India 2017

Authors and Affiliations

  1. 1.Chakrabarti Eye Care CentreTrivandrumIndia

Personalised recommendations