One-piece extended depth of focus intraocular lens implantation in the capsular bag in the presence of a posterior capsule rupture

Introduction and importance: Posterior capsule rupture has historically prevented implantation of one-piece intraocular lenses in the bag. We present a case of extended depth of focus (EDOF) intraocular lens insertion into the capsular bag after posterior capsule rupture with an excellent post-operative outcome. Case presentation: The patient was a 64-year-old female presenting for bilateral refractive exchange to reduce dependence on spectacles. The patient had hypermetropic presbyopia, with no other previous ophthalmic history. She had a non-significant cataract in both eyes. Pre-operative unaided logMAR vision was 0.78 (0.00 pinhole) in her right eye and 0.90 (0.00 pinhole) in her left eye. During right eye surgery, significant posterior pressure was noted throughout, with a shallow anterior chamber. A posterior capsule rupture was noted following phacoemulsification. A one-piece intraocular increased range of focus lens was inserted in the bag with patient consent. It was well centered and stable. On day 13 post-operatively, unaided logMAR vision was 0.0 and N8, and intraocular pressure (IOP) was 10 mmHg. The patient was happy with her visual outcome and the post-operative course was uneventful with week 6 unaided vision being −0.2 and N6 and IOP 10 mmHg and month 6 logMAR 0.0 and IOP 15 mmHg. Visual outcome was similar to the left eye, which did not have a posterior capsular rupture. Clinical discussion: EDOF lenses allow enhanced intermediate vision while maintaining excellent distance vision with minimal compromise. The advanced optical design may mean they are sensitive to tilt and decentration, but studies show they are less affected than trifocal lenses. Conclusions: Dependent on careful assessment of the individual case, one-piece intraocular lens implantation into the capsular bag after posterior capsule rupture may be possible. This can be especially useful for premium intraocular lenses, which are often designed as one-piece lenses not suitable for sulcus insertion.