Posterior capsule rupture puts patients at risk of early pseudophakic RD

This retrospective study found a high risk of retinal detachment (RD) following cataract surgery complicated by posterior capsule rupture (PCR). Based on the evidence gathered in their review, the authors offer an excellent guide to optimal postoperative management for patients with PCR, including close follow-up with dilated fundoscopy within the first 2 months after surgery.

Using the United Kingdom National Ophthalmology Database, the authors identified 129 patients (131 eyes) who had pseudophakic RD surgery. Of those, 36 eyes experienced PCR during cataract surgery. Median time to RD surgery was 44 days in the PCR group compared with 6.3 months for patients who did not experience PCR.

Surgeon grade was the only identifiable risk factor, suggesting that more junior surgeons may not be as skilled at “tidying up” after vitreous loss and ensuring that no strands of vitreous remain in the corneal wound or tangled around the IOL. Vitreous remnants could increase the risk of tractional retinal tears during posterior vitreous detachment, a main cause of retinal tears and subsequent retinal detachments.

The authors make several practical recommendations for follow up care that all surgeons should adopt, such as counseling those patients with PCR a to be attentive for signs and symptoms of retinal detachment, possibly as far out as 3 to 4 after surgery. This study also underscores the benefit of learning techniques to avoid intraoperative and postoperative vitreous traction following posterior capsule rupture during cataract surgery.