Management of capsular rupture and vitreous loss in cataract surgery

Every eye surgeon has experienced – or will experience – that sinking feeling when the posterior capsule is ruptured and vitreous comes forward into the anterior chamber. At that moment everything changes, including the heart rate of the surgeon and the possible outcome for the patient. But all is not lost. If the theatre team are well prepared, the situation can be managed calmly and professionally in order to achieve the best possible visual result. It is most important to remove every trace of vitreous from the wound and anterior chamber. Failure to achieve this increases the risks of leakage, of infection due to a vitreous wick, or of vitreous traction that may lead to cystoid macular oedema or retinal detachment. In an ideal world, automated vitrectomy should be the procedure of choice to deal with vitreous loss; however, if the equipment is unavailable, it may be necessary to resort to the 'sponge and scissors' vitrectomy method. Implanting an intraocular lens (IOL), although desirable, should not be under-taken at any cost if it will involve further trauma to the eye. It is worth mentioning that pressure from the speculum is often to blame for the difficulty surgeons experience in dealing with capsular rupture and vitreous loss. Therefore, it is always advisable to make sure that the speculum is not pressing on the eye. Below, five ophthalmologists from around the world present their tips on managing this complication. Their opinions and methods differ, depending upon individual circumstances and available resources. Capsular rupture is a dreaded complication of cataract surgery; it jeopardises the chances of inserting a posterior lens and therefore obtaining the ideal optical correction of the patient's aphakia after the operation. However, if this complication does occur, do not panic: most cases can be salvaged. Tip 1 Stop everything. Sit back and think. Get your vitrector ready while thinking. The Guerder Vitron anterior vitrectomy machine is ideal and should be made available to all cataract surgeons. You will have to perform an anterior vitrectomy. Try to preserve as much capsule as possible while you do this. Tip 2 After you have done a vitrectomy, if you are not sure how much capsule remains it may be wise to close the incision and consider implanting a secondary iol. Later, you can use the slit lamp to visualise the remaining capsule and plan your operation. Tip 3 If you have done a …