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POSTERIOR CAPSULAR

RUPTUREDr.Prathibha.M.C

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RECOGNITION OF RISK FACTORS FOR PC

RUPTURE

Patient factor Surgeon factorType ofcataract

Associatedfactor withcataract

Compliant eye

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PATIENT FACTOR

Deep set eyes

Inability of the patient to lay supine

Short neck

COPD

Cor pulmonale

Obesity

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SURGEON FACTOR

During training..during transition to learn

new techniques

Topical anesthesialearning curve

Aggressive and inappropriate phaco parameters

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TYPE OF CATARACT

Pre existing posterior capsule defect- congenital;

traumatic

Posterior lenticonus

Hard cataract White mature cataract

Cataract following VR surgery

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ASSOCIATED FACTORS

PxF

Small pupil

Subluxated cataract

Previous trauma

Zonular weakness with systemic disorder

Increased AxL with deep anterior chamber

Shallow AC

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COMPLIANT EYES

High myopia

Post vitrectomy

Trauma

Inflammaation

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PATHOGENESIS OF PCR

Discontinuity in therhexis margin

Vigorous hydrodissection

Mechanical traumaduring dialing the nucleus

Sculpting nuclear divisionand fragmentremoval..sudden occlusionbreak response

Irrigation and aspiration

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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

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PREVENTION

Pre-operative evaluation

Couselling

Surgical manuevers

Reducing the AFR, Vacuum,U/S in stepwisemanner prevents sudden occlusion break

response

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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

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PCR WITHVL

Vitrectomy- high cut rtae .low vacuum.low

Frwith minimal bottle height

Adequte vitrectomy. Round regular

pupil..sweep with iris spatula over the pupil alsoin 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

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During sculpting

During division

During fragment removal

During I/A

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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