Скачать или смотреть Preventing Posterior Capsular Rent in Phacoemulsification Cataract Surgery

Preventing posterior capsular rent in phacoemulsification surgery requires meticulous surgical technique and careful consideration of various factors. Here are some strategies that can help minimize the risk of posterior capsular rent during the procedure:
Patient Selection: Assess the patient's preoperative risk factors, such as advanced cataracts, weak zonules, and pseudoexfoliation syndrome. These factors can increase the risk of posterior capsular complications.


Gentle Hydrodissection: Employ a gentle hydrodissection technique to separate the nucleus from the surrounding cortex. Avoid excessive fluid injection, which can increase intraocular pressure and stress the capsule.


Capsulorrhexis Technique: Perform a well-centered and appropriately sized continuous curvilinear capsulorrhexis (CCC). A properly sized CCC reduces the chances of excessive stress on the capsule during phacoemulsification.
Viscoelastic Agents: Use cohesive viscoelastic agents to maintain anterior chamber stability and provide protection to the posterior capsule. These agents create a barrier between the nucleus and the capsule, reducing the risk of inadvertent capsule damage.


Hydrodelineation: Employ hydrodelineation to further separate the nucleus from the capsule. This technique minimizes stress on the capsular bag during nucleus rotation.


Chop Technique: Use a gentle and controlled chop technique for nucleus fragmentation. Avoid excessive force and leverage, which can stress the capsule.
Phaco Parameters: Use low-energy phaco parameters to emulsify the nucleus. Lower power settings reduce the risk of posterior capsule rupture due to excessive ultrasound energy.


Cortex Aspiration: Carefully aspirate the cortex, ensuring that you are not pulling or pushing on the capsule. Use low vacuum levels and avoid abrupt changes in aspiration flow.


Capsular Polishing: After cortex removal, gently polish the posterior capsule to remove any remaining lens epithelial cells. This can reduce the risk of postoperative capsule opacification (PCO).
IOL Insertion: Choose an appropriate intraocular lens (IOL) and insertion technique. Utilize an injector system that minimizes stress on the capsule during IOL implantation.


Anterior Vitrectomy: If a posterior capsular rent occurs, consider performing an anterior vitrectomy to prevent vitreous prolapse. This requires additional skill and training.


Proper Wound Construction: Ensure that your corneal incisions are well-constructed and watertight. Improper wound closure can lead to postoperative complications, including capsule-related issues.


Surgeon Experience: Phacoemulsification surgery requires a high level of skill and experience. Surgeons with more experience are generally better equipped to handle unexpected complications and minimize their impact.


Constant Communication: Maintain constant communication with the surgical team, especially during critical steps of the procedure. This ensures that everyone is on the same page and can respond promptly to any challenges that arise.
Ultimately, the prevention of posterior capsular rent in phacoemulsification surgery involves a combination of careful planning, meticulous technique, and a deep understanding of the patient's anatomy and risk factors. Regular training, continuous learning, and adherence to best practices can significantly contribute to successful surgical outcomes and reduced complications.