Key Findings from a Large Retrospective Study (2014–2018)
As vitreoretinal surgeons, we are often called upon to manage complications arising from cataract surgery, with posterior capsular rupture (PCR) being one of the most significant. A recent large-scale study from Moorfields Eye Hospital provides updated insights into when PCR occurs and how it influences surgical decision-making—information crucial for our planning and consultations.
📊 When Does PCR Happen?
The study analyzed 1,042 eyes with PCR and found:
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Phacoemulsification is the most common stage for PCR (60% of cases).
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Irrigation/Aspiration (IA) is second (24%).
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Later stages (IOL implantation, viscoelastic removal, wound hydration) accounted for less than 15% combined.
Takeaway: While phaco remains the highest-risk step, surgeons should maintain vigilance through all stages, especially during cortical cleanup.
🔍 Association with Anterior Capsular (AC) Tears
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15% of PCR cases had an accompanying AC tear.
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When an AC tear was present, PCR was more likely to occur earlier (hydrodissection & phacoemulsification).
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Eyes with AC tears were less likely to receive in-the-bag IOL placement (4.5% vs. 12.4% without AC tear).
Implication: Anterior capsule integrity is a key predictor of PCR timing and IOL placement strategy.
👁️ Vitreous Loss & IOL Placement
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80% of PCR cases involved vitreous loss.
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IOL placement in the ciliary sulcus was most common (60%), followed by sulcus optic capture (19%).
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Only 11% had in-the-bag placement.
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8% were left aphakic, often due to dropped lens fragments or inadequate capsular support.
For VR Surgeons: Be prepared for sulcus-placed lenses or aphakic eyes when managing post-cataract complications.
🛠️ Technological Impact
The decline in PCR during IA compared to older studies is attributed to:
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Bimanual IA techniques (greater stability, better access).
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Silicone-tipped instruments (reduced metal-contact trauma to the posterior capsule).
✅ Key Recommendations for Cataract Surgeons
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Identify AC tears early—they increase early-stage PCR risk.
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Consider sulcus or optic-capture IOL placement when PCR occurs.
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Use bimanual/silicone-tip IA to reduce PCR risk during cortical cleanup.
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Document tear morphology—size and margins guide IOL placement.
❓ 5 MCQs for Self-Assessment
Test your understanding of the study’s key points:
PCR in Cataract Surgery: Self-Assessment Quiz
Test your knowledge of posterior capsular rupture timing and management based on the recent Moorfields study.
1. According to the study, during which stage of cataract surgery did PCR occur most frequently?
The study found PCR occurred most frequently during phacoemulsification (60% of cases), followed by IA (24%).
2. What percentage of PCR cases in the study were associated with an anterior capsular (AC) tear?
155 out of 1042 eyes (15%) with PCR also had an AC tear.
3. When an AC tear was present, how did it affect the timing of PCR?
With AC tears, PCR was more likely during hydrodissection and phacoemulsification, likely due to extension of the anterior tear.
4. What was the most common location for IOL implantation when PCR occurred?
60% of eyes had IOLs placed in the ciliary sulcus, compared to only 11% in the bag.
5. What technological advancement was credited with reducing PCR risk during IA compared to older studies?
Bimanual IA provides better chamber stability and access, while silicone tips reduce metal-contact trauma to the posterior capsule.
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