Posterior lens capsule rupture in non-diabetic canine cataracts: Pre-operative, intra-operative, and post-operative findings.

PURPOSE: To describe clinical features of non-diabetic canine cataracts with presumed pre-existing posterior capsule rupture (PLCR) and their surgical outcomes. METHODS: Clinical records of 497 non-diabetic canines that underwent elective cataract surgery were reviewed. Twelve canines met the inclusion criteria indicative of PLCR pre-dating surgery. RESULTS: The incidence of presumed pre-existing PLCR was 12/497 (2.4%). Cataracts included were unilateral in 10 out of 12 canines (83.3%) and bilateral in the remaining two (16.7%). Four eyes (28.6%) had clinically detectable pre-operative lens-induced uveitis. The mean age at cataract diagnosis for cases included was 6.6 years, and golden retrievers were the most common breed affected (28.6%). Phacoemulsification surgery was performed at a median time of 110 days (range 17-403 days) after presentation. Pre-existing PLCR was found intra-operatively as a large ellipse spanning the posterior capsule from equator to equator centrally in 12 eyes and peripherally in two eyes. The capsular defect in all eyes with PLCR incorporated a distinct "pseudo-capsule" preventing vitreal presentation and ruling out intraoperative surgeon rupture. Ten eyes (71.4%) received an intraocular lens implant (IOL), and 13 eyes (92.9%) maintained vision throughout a mean follow-up period of 12 months. CONCLUSION: Posterior lens capsule rupture of blunt trauma origin and associated cataract formation, as reported in humans, may also be an infrequent but distinct cause of some cases of non-diabetic canine cataracts. Medical management of phacolytic uveitis and delayed phacoemulsification surgery may be beneficial by allowing time for "pseudo-capsule" development, increasing the likelihood of IOL placement and improved visual outcomes.

The role of sex in intraoperative floppy-iris syndrome.

PURPOSE: To compare the incidence of intraoperative floppy-iris syndrome (IFIS) between male and female patients undergoing phacoemulsification cataract surgery, evaluate risk factors for its appearance in each sex, and assess any differences in the final visual outcomes. SETTING: 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece. DESIGN: Comparative retrospective case-control study. METHODS: Cataract patients with recorded IFIS of any severity occurring over 4 years in a tertiary care ophthalmic center during phacoemulsification surgery were identified and enrolled in a multivariate analysis. RESULTS: The study comprised 3811 eyes of 3213 patients. Of the 1678 female patients (1937 eyes) undergoing cataract surgery, IFIS was observed in 25 eyes (1.29%), whereas the incidence of IFIS in male eyes during the same period was statistically significantly higher (97 [5.17%] of 1874 eyes) (P < .0001). No statistically significant difference in age was found between male patients (72.92 years ± 6.5 [SD]) and female patients (72.04 ± 7.1 years) (P = .56). An intake of α1-receptor blockers was identified in 70 (72.2%) of 97 male IFIS cases and in none of the 25 female IFIS cases (P < .0001). The posterior capsule rupture rate was significantly higher in 7 (28%) of the 25 female IFIS cases compared with 9 (9.28%) of the 97 male IFIS cases (P = .02). The posterior capsule rupture incidence and final corrected distance visual acuity (with spectacles) were shown to correlate with the IFIS severity grade only in female patients (P < .001 and P = .02, respectively). CONCLUSIONS: Although the incidence of IFIS is rarer in female patients, it might significantly affect an increase in the intraoperative events rate and affect the final visual outcome correlating with the severity grade of its appearance. Predisposing risk factors differ between the sexes and surgeons should always be aware of the potentially catastrophic consequences of unforeseen IFIS.

Iatrogenic Posterior Lens Capsule Rupture and Subsequent Complications due to Nd:YAG Laser Vitreolysis for Vitreous Floaters: A Case Report.

Nd:YAG laser vitreolysis has been used as a noninvasive approach to treat visually significant vitreous strands and floaters. However, severe vision-threatening complications may occur. The authors describe a rare case of a 60-year-old woman who had suffered rupture of the posterior lens capsule with subsequent cataract formation 1 week post-Nd:YAG laser vitreolysis in the right eye. The authors performed phacoemulsification, pars plana vitrectomy, and intraocular lens implantation at the ciliary sulcus. At 1 month post-surgery, the patient's visual acuity had not recovered well and optical coherence tomography showed epiretinal membrane (ERM) formation. Thus, she underwent secondary pars plana vitrectomy for ERM removal. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e214-e217.].

Extended focal length intraocular lens implantation in posttraumatic posterior capsular rupture.

We present a case of posterior capsular defect with traumatic cataract after blunt trauma in which an extended focal length intraocular lens (IOL) was implanted in the bag after conventional phacoemulsification and anterior vitrectomy. Anterior segment optical coherence tomography performed preoperatively aided in the confirmation and documentation of the capsular integrity. Intraoperative trocar anterior chamber (AC) maintainer allowed AC maintenance without further complications. IOL was well centered postoperatively at 6 months, and the unaided visual acuity was 20/20 for distance and N8 for near. The report showed that an extended depth of focus IOL can be placed in eyes with ruptured posterior capsule for good visual outcome in posttraumatic young eyes and it may not be considered as a relative contraindication for it.

Influence of an intentionally induced posterior lens capsule rupture on the real-time intraocular pressure during phacoemulsification in canine ex vivo eyes.

OBJECTIVE: To evaluate the changes in the intraocular pressure (IOP) following an intentionally induced posterior lens capsule rupture (PLCR) during phacoemulsification in enucleated canine eyes. Furthermore, to compare the IOPs between different stages of phacoemulsification for two different bottle heights (BH). PROCEDURES: Coaxial phacoemulsification was performed using a venturi-based machine at a 60 or 90 cm BH. A pressure transducer, inserted into the anterior chamber through the peripheral cornea, monitored real-time IOP. For one half of the lens, the sculpt-segment removal (SS) was followed by irrigation/aspiration (IA). The PLCR was intentionally created, and the SS and IA were repeated on the residual lens fragments. RESULTS: For the 60 cm BH, the mean IOP following the PLCR was significantly higher than before the PLCR during SS (28.30 ± 12.56 and 38.71 ± 9.43 mmHg before and after PLCR, respectively) and IA (42.76 ± 12.46 and 47.88 ± 7.10 mmHg before and after PLCR, respectively) stages (P < 0.001). For the 90 cm BH, the mean IOP following the PLCR was also significantly higher than before the PLCR during SS (33.39 ± 11.09 and 58.17 ± 6.89 mmHg before and after PLCR, respectively) and IA (62.39 ± 12.46 and 72.04 ± 8.59 mmHg before and after PLCR, respectively) stages (P < 0.001). CONCLUSIONS: The occurrence of a PLCR led to an increase in IOP during both the SS and IA stages. The elevated IOP after the PLCR might be one of the most important factors for ocular tissue damage, as it reduces ocular perfusion. Additionally, the BH should be reduced following PLCR to prevent complications stemming from the raised IOP.

Posterior argentinean flag-like sign during primary posterior continuous curvilinear capsulorhexis.

We describe a unique complication during primary posterior continuous curvilinear capsulorhexis (PCCC) in a patient with megalocornea scheduled for phacoemulsification with toric multifocal intraocular lens (IOL) implantation. After nucleus emulsification and cortex removal, the capsular bag was filled with cohesive viscoelastic in preparation for PCCC to achieve reverse optic capture of the IOL, thus ensuring stability. However, as soon as the initial puncture was made using a 27-gauge needle to start the capsulotomy, the posterior capsule opening extended peripherally from 0º-180º. This capsule extension was similar to the Argentinean-flag sign in hypermature cataracts, and both are caused by excessive intracapsular pressure. Careful bimanual manipulation was performed to implant the IOL on the desired axis, which occurred uneventfully. At a postoperative visit, the patient exhibited excellent uncorrected visual acuity with a well-aligned IOL.

Posterior argentinean flag-like sign during primary posterior continuous curvilinear capsulorhexis / Sinal da bandeira argentina- like durante capsulorrexis posterior primária

ABSTRACT We describe a unique complication during primary posterior continuous curvilinear capsulorhexis (PCCC) in a patient with megalocornea scheduled for phacoemulsification with toric multifocal intraocular lens (IOL) implantation. After nucleus emulsification and cortex removal, the capsular bag was filled with cohesive viscoelastic in preparation for PCCC to achieve reverse optic capture of the IOL, thus ensuring stability. However, as soon as the initial puncture was made using a 27-gauge needle to start the capsulotomy, the posterior capsule opening extended peripherally from 0º-180º. This capsule extension was similar to the Argentinean-flag sign in hypermature cataracts, and both are caused by excessive intracapsular pressure. Careful bimanual manipulation was performed to implant the IOL on the desired axis, which occurred uneventfully. At a postoperative visit, the patient exhibited excellent uncorrected visual acuity with a well-aligned IOL.

RESUMO Os autores demonstram uma complicação durante a realização de uma capsulo tomia circular contínua posterior (CCCP) em um paciente com megalocórnea programado facoemulsificação com implante de lente intraocular (LIO) tórica multifocal. Após a remoção do núcleo e córtex, o saco capsular foi preenchido por viscoelástico coesivo com finalidade de prepará-lo para realização da CCCP e com isso assegurar o correto alinhamento do implante no eixo desejado. Entretanto, assim que a agulha de 27-gauge foi utilizada para confecção puntura inicial da capsulotomia, imediatamente a cápsula posterior se abriu até periferia de 0-180 graus, similar à lesão capsular vista no sinal da Bandeira Argentina em cataratas hipermaduras, ambos causados por pressão excessiva intracapsular. Manipulação cuidadosa foi realizada para implantação da lente no eixo correto, a qual aconteceu sem intercorrências. No pós-operatório, a paciente apresentou uma excelente acuidade visual sem correção com LIO corretamente alinhada no eixo desejado.

Lens Capsule Perforation Without Inflammation in 4 Rabbits From Intravitreal Injection Studies.

Historically, it was thought that lens protein was sequestered, and injury to the lens capsule causing release of lens material into the eye would always result in ocular inflammation. Currently, it is believed that lens antigens are recognized as self, subject to normal T-cell tolerance. Three different single-dose intravitreal injection/implantation studies of 4 different test materials, ranging from 4 to 6 weeks in length, were performed in New Zealand White rabbits. The test materials included polymer microspheres, polymer rods, a solvent, and a hydrogel. Intravitreal injection/implantation procedures were performed on day 1, and indirect ophthalmoscopy and slit-lamp biomicroscopy examinations were performed by board-certified veterinary ophthalmologists periodically throughout the course of each study. None of the affected animals received corticosteroids or other immunomodulatory agents during the course of the studies. Four rabbits had perforation of the posterior lens capsule during the injection/implantation procedure on day 1, visible on clinical ophthalmic examination as lens capsule alterations described as "lens hits" and/or incipient posterior cataracts. Findings on slit-lamp biomicroscopy examination were limited to vitreous cells in 2 of the animals, although not centered on the area of lens capsule disturbance. Histologically, there was no evidence of inflammation in association with extruded lens protein material in any of the affected eyes. These results indicate that iatrogenic damage to the lens capsule during aseptically performed intravitreal injections/implantations does not appear to induce inflammation in rabbits.

Intraocular lens scaffold technique to prevent posterior capsule rupture in cases of Morgagnian cataract.

We describe a technique for performing safe phacoemulsification of a Morgagnian cataract using the intraocular lens (IOL) scaffold. An IOL scaffold has been used in cases in which posterior capsule rupture has occurred, leaving nonemulsified nuclear pieces. The scaffold provides a barrier that prevents the nuclear fragments from falling posteriorly into the vitreous cavity. Our technique uses the IOL as a scaffold to prevent the vulnerable posterior capsule from rupturing during nuclear emulsification in Morgagnian cataract. The technique prevents rupture of the floppy posterior capsule by providing a constant support to it. The scaffold provides stable inflation of the capsular bag and prevents inadvertent emulsification. Concurrently, it prevents dehiscence of weak zonular fibers by minimizing the stress on the zonular apparatus.

Cataract formation after YAG laser vitreolysis: importance of femtosecond laser anterior capsulotomies in perforated posterior capsules.

PURPOSE: To report a patient who developed a white cataract after Nd:YAG laser vitreolysis with a posterior capsule defect. METHODS: Femtosecond laser-assisted capsulotomy was performed for optic capture fixation in a patient with a cataract due to a posterior capsule defect after Nd:YAG laser-vitreolysis. RESULTS: A 55-year-old, highly myopic woman presented with visual impairment 4 days after Nd:YAG laser vitreolysis due to preexisting floaters. The slit-lamp examination showed a mature white cataract; therefore, the intactness of the posterior capsule could not be judged. The patient underwent cataract surgery with femtosecond laser-assisted capsulotomy. Intraoperatively, a highly disrupted posterior capsule was observed. Intraocular lens (IOL) was implanted into the ciliary sulcus and the anterior circular and centered capsulotomy was used for posterior optic capture fixation. Then vitrectomy was performed. No intraoperative or postoperative complications occurred. CONCLUSIONS: YAG laser vitreolysis presents a new and promising therapeutic approach for floaters. However, the complications are unknown. We describe the induction of cataract as a major complication. Furthermore, the femtosecond laser can ensure a circular and complete anterior capsulotomy, which is essential for optic capture fixation in these cases.

Isolated posterior capsular split limited by Weiger's ligament after blunt ocular trauma in a child mimicking posterior lenticonus.

A 9-year-old boy presented with a posterior capsular split in the lens following a blunt ocular injury. This split was probably limited by the margins of the Weiger's ligament with opacification of the anterior vitreous face along the patellar fossa producing an appearance of posterior lenticonus.

Safety Profile of Venturi Versus Peristaltic Phacoemulsification Pumps in Cataract Surgery Using a Capsular Surrogate for the Human Lens.

PURPOSE: To compare the risk of capsular rupture of the human lens during cataract surgery from contact by phacoemulsification needles using different vacuum pumps, ultrasound modalities, and contact angles. DESIGN: Experimental laboratory investigation. METHODS: The John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, was the setting for this study. A Signature (Abbott Medical Optics, Inc) phacoemulsification machine was used in peristaltic and Venturi vacuum modes with transversal and micropulsed ultrasound. Contact was made with a capsular surrogate to achieve tip occlusion or tip contact only. Breakage rates were calculated by analyzing the capsular surrogate under a surgical microscope. RESULTS: Venturi and peristaltic pump modes had similar risk of capsular rupture, regardless of whether the data were analyzed with tip occlusion data included (44.2% peristaltic vs 40.2% Venturi, P = .047) or excluded from the analysis (66.3% peristaltic vs 60.3% Venturi, P = .013). Transversal ultrasound was significantly more likely to cause capsular rupture than micropulsed ultrasound (69.8% vs 56.8%, P < .0001). Tip contact was significantly more likely than tip occlusion to cause capsular rupture (63.3% vs 0%, P < .0001). CONCLUSIONS: There is no significant difference in risk of capsular rupture using Venturi rather than peristaltic vacuum pumps, while transversal seemed to increase the risk when compared to micropulsed ultrasound. Tip occlusion is not a risk factor for capsular rupture, as all breaks in the capsular surrogate occurred with tip contact.

Accuracy of 3 imaging modalities for evaluation of the posterior lens capsule in traumatic cataract.

PURPOSE: To compare the accuracy of 3 imaging modalities for preoperative evaluation of the posterior lens capsule in traumatic cataract. SETTING: Farabi Eye Hospital, Tehran, Iran. DESIGN: Case series. METHODS: The study comprised eyes with traumatic cataract opaque enough to prevent visualization of the posterior lens capsule on slitlamp examination. To detect posterior lens capsule rupture before surgery, imaging was performed with 20 MHz echography (Eye Cubed), anterior segment optical coherence tomography (AS-OCT) (Visante model 1000), and Scheimpflug imaging (Pentacam). All patients subsequently had cataract extraction, and the intraoperative findings of the posterior lens capsule were compared with the preoperative findings of the imaging modalities. RESULTS: The study enrolled 21 eyes of 21 patients (20 men, 1 woman) with a mean age of 31.5 years ± 1.45 (SD). The nature of trauma was blunt (5 eyes) or sharp (16 eyes). To detect posterior lens capsule rupture, the sensitivity and specificity were, respectively, 80% and 86% for 20 MHz echography, 71% and 77% for AS-OCT, and 62% and 57% for Scheimpflug imaging (95% confidence intervals: sensitivity, 30.00-90.32; specificity, 54.81-92.95). Insufficient resolution for posterior lens capsule evaluation occurred in 33.3% cases for AS-OCT and 57.1% cases for Scheimpflug imaging. The accuracy of 20 MHz echography, AS-OCT, and Scheimpflug imaging was 76.1%, 61.9%, and 42.9%, respectively. CONCLUSION: In the evaluation of the posterior lens capsule in eyes with traumatic cataract, 20 MHz echography had higher accuracy than AS-OCT and Scheimpflug imaging. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

[Results of intraocular lens implantation on top of the anterior capsule in cases of phaco complications].

UNLABELLED: Posterior capsule rupture during cataract extraction requires that the intraocular lens (IOL) implanted on top of the capsular bag was stable and well-centered. The objective of this study was to evaluate the results of Rayner C-flex aspheric and M-flex aspheric (United Kingdom) IOLs implantation on top of the capsular bag and their stability in patients with phaco complications. MATERIAL AND METHODS: A total of 2556 phacoemulsification cases were analyzed. Posterior capsule rupture as a complication occurred in 7 cases, that is 0.27%. In all patients Rayner C-flex (5) and M-flex (6) IOLs were implanted on top of the capsular bag according to the initial calculations and with no modifications in the procedure. The 2nd-year follow-up included measurement of the corneal compensated intraocular pressure (IOP) and B-mode and 3D grey-scale ultrasound in order to assess the structures of the anterior segment and to check the position of the IOL. RESULTS: All surgeries yielded positive clinical results. In 2 years after the intervention uncorrected visual acuity averaged 0.7-0.13, corrected-- 0.91+0.07; clinical refraction: sphera-- +0.46 +/- 0.26 diopters, cylinder-- 0.71 +/- 0.29 diopters. The shape and other parameters of Rayner IOLs contribute to their long-term stability. Postoperative lOP in the treated eye was higher than in the fellow nonoperated eye (13.9 +/- 0.76 and 11.8 +/- 0.59 mmHg correspondingly) but the difference lied within the range of normal asymmetry. CONCLUSION: The 3D ultrasound technology is an informative mean of monitoring the position of the IOL in case of its extracapsular implantation; a comparatively higher IOP in the operated eye does not exceed the range of normal asymmetry between the two eyes; Rayner C-flex and M-flex IOLs remain stable and well-centered after being implanted on top of the capsular bag.