Posterior Capsular Rupture with Vitreous Loss in Assisted Surgeons-Towards a Better Understanding

Author(s): Tamer Adel Refai

Aim: To evaluate cases with posterior capsular rupture with vitreous loss among phacoemulsification patients performed by assisted surgeons in research Institute of ophthalmology. 

Methods: Fourteen (14) eyes of fourteen patients in which posterior capsular rupture with vitreous loss had happened during phacoemulsification surgery performed by assisted ophthalmic surgeons at one sector of research institute of ophthalmology Giza-Egypt between February 2018 and August 2019. Patient age was recorded, the machine used in phacoemulsification, the operative step in which the capsular rupture and vitreous loss occurred, the nucleus grade (an indicator of the difficulty of the procedure) in addition to any added difficulties in the procedure as reported by questionnaire of the surgeon. Collected data were subjected to statistical analysis mainly by Chi-Squared test to compare the relative frequency of existence of the possible risk factors related to posterior capsular rupture and vitreous loss. 

Results: In this study, according to the cataract nuclear grade, the highest percentage of posterior capsular rupture and vitreous loss for nuclear grade III nuclear cataracts (42.86%), although the Chi-squared test denotes a non significant difference (X2=2.55, P>0.05). For the phacoemulsification step, the highest percentage of vitreous loss occurred with the phacoemulsification (phaco II) step (42.86%) followed by the hydromaneuvers step and the phaco-division (i.e., phaco I) step (I14.29% each), followed by other steps, although the Chi-squared test showed a nonsignificant difference (X2=10.8, P>0.05). For the phacomachine used; a higher percentage of posterior capsular rupture and vitreous loss occurred with the Alcon Infiniti with OZil Torsional Handpiece (42.86% of cases), followed by the Oertli Os3 (35.71%) and then the AMO Whitestar Signature machine, however; comparison with the Chi-squared test denotes a nonsignificant difference (X2=1.0, P >0.05). Regarding the presence of additional operational difficulties, a relatively higher percentage of posterior capsular rupture and vitreous loss occurred in the presence of both small pupil intraoperatively (14.29%) as well as poor red reflex (14.29%). 

Conclusion: during performing phacoemulsification by assisted surgeons, in order to decrease the incidence of posterior capsular rupture with vitreous loss, special care should be taken while performing phacoemulsifiaction of the nucleus (i.e; phaco II), and it is better to avoid working on grade III nuclear density and on the Oertli-phaomachime and it is recommended to have good pupillary dilatation with good red reflex.

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