Posterior capsule tears using phaco-emulsification causes, prevention and management

A 2-year study of posterior capsule tears during cataract extraction and lens implantation was carried out at the Gimbel Eye Centre. 7174 consecutive cases of cataract extraction were analyzed in a prospective study. 7159 cases or 99.8% were accomplished using phaco-emulsification. Eight or 0.1% were by extracapsular extraction (ECCE), 2 of which were planned and 6 which were converted from phaco-emulsification because the nucleus was too dense. Seven or 0.1% were by intracapsular extraction (ICCE), 3 of which were planned and 4 which were converted from phaco-emulsification, all because the zonular fibres were too loose to support the capsule. Of the 7169 cases attempted by phaco-emulsification, an intraoperative posterior capsule (PC) tear occurred in 36 cases or an incidence of 0.5%. Of these 36 cases, 35 involved planned intraocular lens implantation, all of which were achieved. The causes of PC tears, their management, and outcomes were examined. The contribution of anterior Continuous Circular Capsulorhexis (CCC) in the prevention of posterior capsule tears is discussed and the application of this same principle to posterior continuous circular capsulorhexis (PCCC) as developed by the author for management of some posterior capsule tears is presented.