Posterior Capsular-Zonular Disruption in Planned Extracapsular Surgery

The incidence of inadvertent posterior capsule-zonular disruption at each stage of planned extracapsular cataract extraction was studied in a consecutive series of 250 cases. Disruption occurred during nucleus expression in 0.8%, during cortical cleanup in 3.2%, during removal of anterior capsular flaps in 0.4%, during polishing of the posterior capsule in 0.4%, and during posterior chamber lens (Sinskey-style) implantation in 0%. No cases of subluxation of the posterior chamber lens were observed (mean follow-up, 22 months). The overall incidence of posterior capsule-zonular disruption was 4.8%. Vitreous loss occurred in one half of these cases (2.4% of eyes). No cases of dislocation of the nucleus into the vitreous occurred. In 50% of the cases of posterior capsule-zonular disruption (2.4% of eyes), prompt recognition and proper management avoided disruption of the vitreous face. In 80% of these cases with posterior capsule-zonular disruption but intact vitreous face, it was possible to remove sufficient cortex and to proceed with uncomplicated posterior chamber lens implantation.