AAO 2019 Video Program
    Cataract/Anterior Segment

    Posterior capsular (PC) rupture during cataract surgery is one of the most devastating complications the surgeon may face. The link between the anatomy of retrolenticular space and capsular complications is not well defined. We used intraoperative OCT (iOCT) to assess the Berger space and Wieger ligament at the final stages of phacoemulsification and IOL implantation. In a substantial number of patients (up to 70%), we were being able to detect anterior vitreous detachment from the posterior lens capsule. Pathologic connections between the anterior chamber (AC) and Berger space were confirmed with the help of triamcinolone injection into the AC followed by iOCT. We suggest Wieger ligament lysis associated with weak zonules to be the main factors responsible for intraoperative aqueous misdirection syndrome, leading to displacement of the PC forward and making it more susceptible to aspiration during the final steps of phacoemulsification.