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Surgical Pearls to Minimize the Incidence of Posterior Capsule Rent

  • Jeewan S. Titiyal
  • Manpreet Kaur
  • Tarun Arora
Chapter

Abstract

The lens capsule in human eyes has the maximum thickness in the anterior midperipheral region located just anterior to the site of insertion of the zonules. The capsule thickness increases with age, especially at the anterior pole, while it stabilizes in the midperipheral zone or slightly decreases after the seventh decade. From this point, the posterior capsule becomes progressively thinner and also diminishes with age, except for the thinnest, but stable posterior pole [1]. The posterior capsule acts as an anatomical barrier between the anterior and the posterior segment and limits the spread of infectious and inflammatory processes [2].

Keywords

Anterior Chamber Cataract Surgery Posterior Capsule Anterior Chamber Depth Anterior Capsule 
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.

Notes

Conflict of Interest

No author has any potential conflict of interest or financial disclosure. The study did not receive any financial or material assistance.

References

  1. 1.
    Barraquer RI, Michael R, Abreu R, Lamarca J, Tresserra F. Human lens capsule thickness as a function of age and location along the sagittal lens perimeter. Invest Ophthalmol Vis Sci. 2006;47:2053–60.CrossRefPubMedGoogle Scholar
  2. 2.
    Beyer TL, Vogler G, Sharma D, et al. Protective barrier effect of the posterior lens capsule in exogenous bacterial endophthalmitis – An experimental primate study. Invest Ophthalmol Vis Sci. 1984;25:108–12.PubMedGoogle Scholar
  3. 3.
    Desai P. The national cataract surgery survey: II clinical outcomes. Eye. 1993;7:489–94.CrossRefPubMedGoogle Scholar
  4. 4.
    Siepser SB, Kline OR. Aborted posterior chamber intraocular lens insertions: a ‘second choice’. Am Intraocul Lens Soc J. 1984;10:51–2.CrossRefGoogle Scholar
  5. 5.
    Vail D. After results of vitreous loss. Am J Ophthalmol. 1965;B59:573–86.CrossRefGoogle Scholar
  6. 6.
    Pearson PA, Owen DG, Maliszewski M, et al. Anterior chamber lens extraction after vitreous loss. Br J Ophthalmol. 1989;73:596–9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Frost NA, Sparrow JM, Strong NP, et al. Vitreous loss in planned extracapsular cataract extraction does lead to a poorer visual outcome. Eye. 1995;9:446–51.CrossRefPubMedGoogle Scholar
  8. 8.
    Jaffe NS, Clayman HM, Jaffe MS. Cystoid macular edema after intracapsular and extracapsular cataract extraction with and without an intraocuar lens. Ophthalmology. 1982;89:25–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Hingorani M, Wong T, Vafidis G. Patients’ and doctors’ attitudes to amount of information given after unintended injury during treatment: cross sectional questionnaire survey. BMJ. 1999;318:640–1.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Balent A, Civerchia LL, Mohamadi P. Visual outcome of cataract extraction and lens implantation complicated by vitreous loss. J Cataract Refract Surg. 1988;14:158–60.CrossRefPubMedGoogle Scholar
  11. 11.
    Johansen J, Theodorsen FP, Corydon L. Visual outcome following complicated extracapsular cataract extraction. J Cataract Refract Surg. 1992;18:577–81.CrossRefPubMedGoogle Scholar
  12. 12.
    Trinavarat A, Neerucha V. Visual outcome after cataract surgery complicated by posterior capsule rupture. J Med Assoc Thai. 2012;95 Suppl 4:S30–5.PubMedGoogle Scholar
  13. 13.
    Desai P, Minassian D, Reidy A. National cataract surgery survey 1997–8: a report of the results of the clinical outcomes. Br J Ophthalmol. 1999;83:1336–40.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Chen M, Lamattina KC, Patrianakos T, et al. Complication rate of posterior capsule rupture with vitreous loss during phacoemulsification at a Hawaiian cataract surgical center: a clinical audit. Clin Ophthalmol. 2014;8:375–8.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Narendran N, Jaycock P, Johnston RL, et al. The Cataract National Dataset electronic multicentre audit of 55 567 operations: risk stratification for posterior capsule rupture and vitreous loss. Eye. 2009;23:31–7.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(9):1377–82.CrossRefPubMedGoogle Scholar
  17. 17.
    Osher RH, Cionni RJ. The torn posterior capsule: its intraoperative behaviour, surgical management and long term consequences. J Cataract Refract Surg. 1990;16:490–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Moreno J, Duch S, Lajara J. Pseudoexfoliation syndrome: clinical factors related to capsular rupture in cataract surgery. Acta Ophthalmol. 1993;71:181–4.CrossRefGoogle Scholar
  19. 19.
    Guzek JP, Holm M, Cotter JB, et al. Rick factors for intraoperative complications in 1000 extracapsular cases. Ophthalmology. 1987;94:461–6.CrossRefPubMedGoogle Scholar
  20. 20.
    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
  21. 21.
    Donnenfeld ED, Perry HD, Wittpenn JR, Solomon R, Nattis A, Chou T. Preoperative ketorolac tromethamine 0.4% in phacoemulsification outcomes:pharmacokinetic-response curve. J Cataract Refract Surg. 2006;32:1474–82.CrossRefPubMedGoogle Scholar
  22. 22.
    Chen YA, Hirnschall N, Findl O. Comparison of corneal wetting properties of viscous eye lubricant and balanced salt solution to maintain optical clarity during cataract surgery. J Cataract Refract Surg. 2011;37:1806–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Dada VK, Sharma N, Dada T. Conjunctival ballooning during phacoemulsification. J Cataract Refract Surg. 2001;27:1904.CrossRefPubMedGoogle Scholar
  24. 24.
    Bhattacharjee K, Bhattacharjee H, Goswami BJ, Sarma P. Capsulorhexis in intumescent cataract. J Cataract Refract Surg. 1999;25:1045–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Jacob S, Agarwal A, Agarwal A, Agarwal S, Chowdhary S, Chowdhary R, Bagmar AA. Trypan blue as an adjunct for safe phacoemulsification in eyes with white cataract. J Cataract Refract Surg. 2002;28:1819–25.CrossRefPubMedGoogle Scholar
  26. 26.
    Kara-Junior N, de Santhiago MR, Kawakami A, Carricondo P, Hida WT. Mini-rhexis for white intumescent cataracts. Clinics. 2009;64:309–12.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Vajpayee RB, Bansal A, Sharma N, Dada T, Dada VK. Phacoemulsification of white hypermature cataract. J Cataract Refract Surg. 1999;25:1157–60.CrossRefPubMedGoogle Scholar
  28. 28.
    Conrad-Hengerer I, Hengerer FH, Joachim SC, Schultz T, Dick HB. Femtosecond laser-assisted cataract surgery in intumescent white cataracts. J Cataract Refract Surg. 2014;40:44–50.CrossRefPubMedGoogle Scholar
  29. 29.
    Koch DD, Liu JF. Zonular encroachment on the anterior capsular zonular-free zone. Am J Ophthalmol. 1988;106:491–2.CrossRefPubMedGoogle Scholar
  30. 30.
    Yeoh R. The ‘pupil snap’ sign of posterior capsule rupture with hydrodissection in phacoemulsification. Br J Ophthalmol. 1996;80:486.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Vasavada AR, Raj SM. Inside-out delineation. J Cataract Refract Surg. 2004;30:1167–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Roberts TV, Sutton G, Lawless MA, Jindal-Bali S, Hodge C. Capsular block syndrome associated with femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2011;37(11):2068–70.CrossRefPubMedGoogle Scholar
  33. 33.
    Vajpayee RB, Sinha R, Singhvi A, Sharma N, Titiyal JS, Tandon R. ‘Layer by layer’ phacoemulsification in posterior polar cataract with pre-existing posterior capsular rent. Eye (Lond). 2008;22(8):1008–10.CrossRefGoogle Scholar
  34. 34.
    Vanathi M, Vajpayee RB, Tandon R, Titiyal JS, Gupta V. Crater-and-chop technique for phacoemulsification of hard cataracts. J Cataract Refract Surg. 2001;27:659–61.CrossRefPubMedGoogle Scholar
  35. 35.
    Osher RH. Slow motion phacoemulsification approach. J Cataract Refract Surg. 1993;19:667 [letter].CrossRefGoogle Scholar

Copyright information

© Springer India 2017

Authors and Affiliations

  • Jeewan S. Titiyal
    • 1
  • Manpreet Kaur
    • 1
  • Tarun Arora
    • 1
  1. 1.Cornea, Cataract & Refractive Surgery ServicesDr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical SciencesAnsari NagarIndia

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