Slow motion analysis of posterior capsule rupture in cataract surgery

Watching surgical video of cases is very helpful to understand the how and when of the complications of cataract surgery. In this case, which was featured yesterday, we can slow down the video to one-third speed in order to find the specific errors which led to the posterior capsule rupture and the complete splitting of the posterior capsule.

The primary issue is the way that the groove was sculpted in the nucleus. The resident surgeon was too linear in the groove creation and this allowed the phaco tip to go completely through the nucleus and puncture the posterior capsule. Then, while cracking the nucleus into halves, this weakness allowed the complete splitting of the posterior capsule. As we saw from yesterday's case, this patient needed a conversion to an extra-capsular technique.

The correct path for sculpting the groove is curved so that it is deeper in the center and shallower in the periphery of the lens nucleus. This is due to the shape of the cataract which is like an M&M candy.