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O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | O C T O B E R 2 0 1 4
necessary.
Is a small pupil more dangerous than a small capsulorhexis?
"Experienced surgeons can operate successfully through a small
pupil," says Dr. Melendez. "But it's extraordinarily difficult to perform
surgery through a smaller capsulorhexis, especially when dealing with
a really dense cataract."
Capsular rupture should occur in less than 1% of cataract patients,
says Richard Hoffman, MD, clinical associate professor of ophthal-
mology at the Casey Eye Institute in Eugene, Ore. However, he says
the risk of rupture jumps to as much as 30% in patients with posteri-
or polar cataracts. Previous vitrectomy surgery or pars plana injec-
tions, especially when the cataracts develop soon after the injec-
tions, are other warning signs of a compromised posterior capsule,
says Dr. Hoffman.
Patients with poste-
rior cataracts often
have a very thin,
weakened, central
posterior capsule
that's more likely to
rupture, so surgeons
should avoid
hydrodissection if
they believe the poste-
rior capsule is com-
promised, says Dr.
Hoffman. To prevent
the bag from ruptur-
ing, he also avoids
rotating the lens in
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