This document discusses signs, predisposing factors, timing, and management of a posterior capsule tear during cataract surgery. A posterior capsule tear can be identified by sudden pupil dilation, a falling away nucleus, or visible vitreous or capsule in the phaco tip. Risk factors include surgeon hand position, poor visibility from fluid, globe torsion, or underlying pathology. Tears often occur late in surgery during nucleus removal or capsule polishing. Management involves injecting viscoelastic to cover the tear and prevent vitreous prolapse, removing any lens fragments, and determining if an anterior or sulcus IOL placement is possible depending on tear size.

2. SIGNS
Sudden deepening of a.c and
momentary pupillary dilatation.
The nucleus falls away and will not come
towards the phaco tip
Vitreous may be aspirated into the phaco tip
The torn capsule or vitreous may be directly
visible

3. Predisposing Factors
 Position of surgeon’s hand - obscuring visibility
 Irrigation fluid pooling
Torsion of the globe
 Poor microscope illumination or alignment
 Poor visibility secondary to pathology : dense
arcus, pteryguim, band keratopathy, corneal scars,
interstitial keratitis

4. When is the Posterior Capsule
is Torn?
• Terminal stages of phaco for
emulsification of last pieces of
endonucleus
• During posterior capsule polishing

5. MANAGEMENT
• Injection of viscoelastic material for expressing it into A.C and
also preventing anterior herniation of vitreous
• Lens glide is passed behind the lens fragment to cover the capsular
defect.
• Lens fragments removed by visco-expression or by phaco
• Vitreous removal from A.C
• If tear is SMALL -may allow implantation of PC-IOL
• If LARGE TEAR-allow ciliary sulcus implantation of a three piece
IOL
MAGNITUDE OF THE
TEAR
VITREOUS PROLAPSE
+/-

8. VITREOUS IN ANTERIOR
CHAMBER