The document discusses risk factors that can increase the risk of posterior capsule rupture (PCR) during cataract surgery. These include preexisting lens conditions, increased age, previous eye trauma or surgery, and other eye conditions that reduce visibility. Systemic factors like inadequate anesthesia or positioning can also increase risk. Signs of an early PCR include changes in the anterior chamber and pupil behavior. Vitreous strands can be detected by sweeping a sponge along the incision. The Viscoat PAL technique uses viscoelastic to support the nucleus and prevent PCR. Depending on the size and location of the rent, an IOL can be placed in the bag or sulcus, or require iris or scleral fixation. Completion of

1. PCR
PRESENTED BY DR ROHIT RAO

2. RISK FACTORS
• Preexisting lens conditions are:
• mature, white, intumescent cataract
• 'black' cat5aract
• posterior polar cataract
• age of the cataract: risk increases with the time the cataract has been present
• age of the patient: risk increases with age.
• history of penetrating or contusive globe trauma
• previous vitrectomy

3. The risk factors relating to other conditions of eye that can increase risk of PCR are:
• Deep orbit, enopthalmos, prominent nose.
• corneal opacity, specially diffuse and central because it reduces visibility
• shallow anterior chamber or small eye: the surgicall space for intraocular maneuver is much
smaller
• High myopia with a big eye and very deep anterior chamber
• Small pupil : PXF, Posterior synechia, chronic use of miotics, diabetes, iris atrophy, or IFIS
(Floppy iris syndrome)
• weak zonulae manifested by phacodonesis, or dislocation of the lens.

4. • Systemic risk factors that can increase the risk of capsule rupture:
• Inadequate anesthesia with excesive eye movements, lid pressure or head and
body movement during surgery
• Musculoskeletal alterations that impede propper positioning of the patient for
surgery
• Neurological and Mental disorders that generate involuntary movements or
inadequate cooperation
• Cardio pulmonary disease that impedes flat position of heavy breathing
• Obesity and short neck that can produce increased vitreous pressure with
shallowing of anterior chamber

5. SIGNS OF EARLY POSTERIOR CAPSULAR TEAR
• Sudden deepening of the anterior chamber with momentary dilatation of the pupil.
• Sudden transitory appearance of a clear red reflex peripherally
• Newly apparent inability to rotate a previously mobile nucleus
• Excessive lateral mobility or displacement of the nucleus and loss of nucleus followability.
• Excessive tipping of one pole of the nucleus
• Partial descent of the nucleus into the anterior vitreous space.

6. • *Sweep a sponge or swab stick along the site of incision. Vitreous if present can
be seen as strands along the section.
• *Sweep the spatula from the anterior chamber angle under the incision towards
the rent. Vitreous if present will be seen getting dragged as it has a tendency to
come towards the wound.

25. • Charles Kelman, MD, popularized the posterior assisted levitation, or “PAL,”
technique
• Use of Viscoat and the Viscoat cannula to support and levitate the nucleus the so-
called Viscoat PAL technique

26. IOL PLACEMENT
• Depends on the site and extent of rent.
• 3-piece IOL in sulcus.
• Small rent place IOL in bag
• After placing,check for IOL stability and centration.
• If required, opt for iris-fixation or scleral fixation of the lens.

27. CONFIRMING THE COMPLETION OF
VITRECTOMY
• Inject air bubble and look for its fragmentation.
• Inject pilocarpine and look for peaking of pupil.
• Inject triamcinolneacetonide to stain vitreous