POSTERIOR CAPSULAR RUPTURE

Dr.Prathibha.M.C

RECOGNITION OF RISK FACTORS FOR PC

RUPTURE

Patient factor

Surgeon factor

Type of cataract

Associated factor with cataract

Compliant eye

PATIENT FACTOR
Deep set eyes Inability of the patient to lay supine Short neck COPD Cor pulmonale Obesity

SURGEON FACTOR
During training..during transition to learn new techniques Topical anesthesialearning curve Aggressive and inappropriate phaco parameters

TYPE OF CATARACT
Pre existing posterior capsule defect- congenital; traumatic Posterior lenticonus Hard cataract White mature cataract Cataract following VR surgery

ASSOCIATED FACTORS
PxF Small pupil Subluxated cataract Previous trauma Zonular weakness with systemic disorder Increased AxL with deep anterior chamber Shallow AC

COMPLIANT EYES
High myopia Post vitrectomy Trauma Inflammaation

PATHOGENESIS OF PCR
Discontinuity in the rhexis margin

Vigorous hydrodissection

Mechanical trauma during dialing the nucleus Sculpting nuclear division and fragment removal..sudden occlusion break response Irrigation and aspiration

IDENTIFICATION AT DIFFERENT STAGES

Pupil snap sign Deepening of AC, loss of counter resistance during sculpting Inability to occlude..sinking nucleus Loss of followability Inability to aspirate corticl matter Unstable IOLvertical tilt

PREVENTION
Pre-operative evaluation Couselling Surgical manuevers Reducing the AFR, Vacuum,U/S in stepwise manner prevents sudden occlusion break response

MANAGEMENT OF PCR

PCR with intact anterior hyaloid face during emulsification Stop all the movements of the probe.dont remove the probe Inject viscoelastic---to tamponade through side portgently remove the probe Elevate the lens from the area of rentdelineate the extent of rent Well defined small rentcontinue with low FR,high vacuum with reuced bottle height,high U/s

PCR WITH VL
Vitrectomy- high cut rtae .low vacuum.low Frwith minimal bottle height Adequte vitrectomy. Round regular pupil..sweep with iris spatula over the pupil also in the wound Main incision and side port sutured with 10-O nylon Intracameral Pilocarpine 1ml +1% vancomycin0.1 ml is injected Contriction of pupil is inducative of absence of vitreous in AC

During sculpting During division During fragment removal During I/A

IOL FIXATION
Extent of PCRintegrity of capsule Small rent- in bag .< than optic size of IOL Sulcus ACIOL Secondary IOL placement Sclera fixated Iris fixated