9 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 9
C
ataract sur-
geons who
claim
they're not
worried
about piercing the posteri-
or capsule with a sharp
instrument or oscillating
phaco tip? "They're either
lying or retired," says Uday
Devgan, MD, a cataract sur-
geon in Los Angeles, Calif.
While posterior capsular
ruptures are rare — it's estimated they occur in 6% of novice sur-
geons' cases and in less than 1% of experienced physicians' proce-
dures — they increase the risks of endophthalmitis and cystoid macu-
lar edema, adverse events that adversely affect patients' post-op
vision. But a rupture impacts more than quality outcomes. Your case
costs and profit margins suffer collateral damage. Consider:
• Surgeons must open 2 or 3 more tubes of viscoelastic to keep the
tear from expanding, and prevent or limit vitreous loss.
• They must use intracameral preservative-free triamcinolone dur-
ing clean-up of the tear to increase visualization of the vitreous that
prolapses into the anterior chamber.
• They must open an anterior vitrectomy pack, use acetylcholine
chloride intraocular solution to constrict the pupil, and administer
Daniel Cook | Executive Editor
• ALWAYS AWARE Jeffrey Whitman, MD, who has performed thousands of cataract surgeries, knows a cap-
sular tear could occur during his next case.
Jeffrey
Whitman,
MD
Pointers to Prevent Posterior Capsular Rupture
Devices and drugs to avoid the complication every cataract surgeon
dreads — when the capsular bag unexpectedly breaks during the case.
