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    Premium IOLs in Posterior Capsular Rent: Rescue Techniques

    AAO 2023 Video Program
    Cataract/Anterior Segment, Premium IOLs

    Posterior capsular rent (PCR) may be encountered in cases planned for premium IOL implantation, and in this video we highlight a spectrum of cases wherein careful surgical manipulations allowed the placement of premium IOLs (toric or multifocal IOLs) in the bag in the presence of a PCR. Premium IOL may be safely placed in the bag in cases with small central PCR that occurs after nuclear emulsification with intact vitreous phase; PCR may be converted into primary posterior continuous curvilinear capsulorrhexis. Toric IOL implantation in larger PCR may be challenging, as the haptics need to be aligned in a specific axis as well. Anterior optic capture of the IOL optic was performed in one featured case, with a rotationally stable IOL until 1 month of follow-up. Large posterior capsule dehiscence in a posterior polar cataract was observed in another case; multifocal IOL was implanted in the bag with anterior optic capture. All cases achieved uncorrected distance visual acuity of 20/25-20/20 at 1 month of follow-up. Toric IOLs implanted in cases with PCR maintained rotational stability until the last follow-up.