Management Of Posterior Capsule Rupture Research Articles

Non-technical skills simulation-based training model for managing intraoperative posterior capsule rupture during cataract surgery.

To develop and implement a simulation-based training model for the management of posterior capsule rupture (PCR) from a non-technical skills (NTS) perspective, and analyse changes in participant's NTS and technical skills (TS). The simulation-based training model consisted of two identical PCR simulations with NTS stressors applied, separated by a predominantly NTS focussed training intervention. Participants' TS and NTS were evaluated by two blinded assessors using the Objective Structured Assessment of Technical Skill (OSATS) global rating scale and the HUman Factors in intraoperative Ophthalmic Emergencies Scoring System (HUFOES) respectively. Paired t-tests were used to establish the difference in mean HUFOES and OSATS scores between initial and repeat simulations; p < 0.05 indicated statistical significance. McGaghie's model of translational outcomes for simulation-based learning was used to establish the simulation model's educational status. Seventeen cataract surgeons of varying training grades participated in the simulation-based training model. NTS improved with statistical significance; mean HUFOES scores increased from 48.7 ± 16.6 to 59.2 ± 14.8 (p < 0.001). Mean OSATS scores increased without statistical significance from 16.0 ± 7.3 to 17.9 ± 8.3 (p = 0.07). This simulation model achieved Level 1 (internal acceptability) and Level 2 (contained effects) according to McGaghie's model. This novel simulation-based training model was designed to improve the NTS required for managing intraoperative PCR, through the provision of an interactive training session. Statistically significant improvements in participants' NTS in combination with statistically insignificant improvements in TS demonstrate that the simulation-based training model has specificity within the NTS domain.

Clinical outcomes of management of posterior capsule rupture with air bubble techniques.

To introduce a new surgical technique, air-bubble technique for the management of posterior capsule rupture (PCR) and to evaluate the safety and efficacy of the technique. A retrospective case series analysis of 24 eyes of 24 patients, in which the air bubble technique was used for the management of PCR, was performed. Once PCR occurred, a dispersive ophthalmic viscosurgical device (OVD) was injected into the tear. And small volumes (0.2-0.3 mL) of air bubbles were injected beneath the OVD. The air bubble served as a physical barrier and supported the posterior capsule. After surgery, none of the patients had serious complications during the follow-up period of 1y. Extension of the PCR size occurred in only 2 cases, and additional OVD injection was required only in 3 cases. Air bubbles imparted great stability to the nuclear pieces and the posterior capsule. The air-bubble technique may be considered a safe and effective procedure for managing a PCR. It may be of value to the inexperienced cataract surgeon.

Response to: Comments on 'Confidence of ophthalmology trainees in the management of posterior capsule rupture and vitreous loss'.

Response to: Comments on 'Confidence of ophthalmology trainees in the management of posterior capsule rupture and vitreous loss'

Treatment of posterior capsule rupture in phacoemulsification

Objective To investigate the causes and management of posterior capsule rupture in phacoemulsification surgery. Methods The causes and management of posterior capsule rupture phacoemulsification surgery in 709 eyes of 680 cases between 8th May 2014 to 30th November 2014 in our hospital were analysed retrospectively. Results There were 21 eyes complicated with posterior capsule rupture.Of them 8 eyes happened during emulsifing lens nuclear, 9 eyes occurred when aspirating cortex, 3 eyes happened when adjusting intraocular lens, 1 eyes occurred when cutting off the curling anterior capsule. In 21 cases with posterior capsule rupture, 9 eyes were treated with intraocular lens(IOL) implantation, 10 eyes with IOL ciliary sulcus implantation , 1 eye with IOL suspension implantation, 1 eye wearing glass without IOL implantation. The BCVA were all above 0.3. Patient satisfaction rate was 100%. Conclusion For posterior capsule rupture in phacoemulsification cataract surgery timely and accurate treatment will get satisfied result. Key words: Cataract; Phacoemulsification; Posterior capsule rupture, in the surgery

Confidence of ophthalmology specialist trainees in the management of posterior capsule rupture and vitreous loss

PurposeTo ascertain ophthalmology trainee confidence in managing posterior capsule rupture (PCR) and vitreous loss.MethodsAn electronic survey was distributed to ophthalmology trainees in a single UK postgraduate training Deanery. Data collected included the stage of training, number of completed cataract operations, cumulative PCR rate, number of PCRs personally managed by the trainee, previous vitrectomy experience during vitreoretinal rotations, and attendance at advanced phacoemulsification courses. Trainees self-evaluated their confidence in managing PCR with vitreous loss, including the management of specific aspects of the procedure.ResultsAcross training grades, only 9.1% (2/22) felt confident managing PCR without senior support. Respondents were most confident with fluidic parameters and IOL considerations, but 77.3% (17/22) lacked confidence in avoiding a dropped nucleus. Eleven respondents had completed >350 cases (mean 576; range 383-1087). In this subgroup, mean cumulative PCR rate was 2.1% (range 0.9-4.9%), and trainees personally managed a mean 3.5 cases of PCR (range 1-7). Only 18.2% felt they could manage PCR and vitreous loss without senior support, and 45.5% stated they were not confident in avoiding a dropped nucleus. The most experienced trainee (1087 cases) had personally managed PCR just six times, and three trainees with >350 cases had only managed PCR once each.ConclusionsThe Royal College of Ophthalmologists' requirement of 350 completed cases appears insufficient for independent cataract surgery, as opportunities to manage complications as a trainee are scarce. A competency-based assessment framework may be preferable, with a more targeted approach to training incorporating surgical simulation within the formal curriculum.

Pseudo anterior capsule barrier for the management of posterior capsule rupture

A technique that uses an implanted intraocular lens (IOL) to create a barrier for the management of posterior capsule rupture is described. When a rupture occurs, surgery is halted and a dispersive ophthalmic viscosurgical device (OVD) injected into the anterior chamber to prevent vitreous prolapse. The remaining nucleus is maneuvered into the anterior chamber away from the pupillary space. The posterior capsule tear is converted into a continuous curvilinear capsulorhexis where possible. Dissociated anterior vitrectomy is performed as indicated, keeping the large nuclear fragments trapped in the OVD-filled anterior chamber. An IOL is implanted in the capsular bag or sulcus with optic capture through the anterior capsulorhexis. Using reduced parameters, phacoemulsification of the remaining fragments is completed over the IOL, which functions as a barrier to seal off the vitreous cavity. Residual nuclear fragments and vitreous are cleared from beneath the optic by placing the vitreous cutter under the optic, recapturing the optic before the instruments are removed from the eye. The author has no financial or proprietary interest in any material or method mentioned.

Causes and management of posterior capsule rupture in phacoemulsification

Objective To discuss the causes and treatment measurements of posterior capsule rupture in the phacoemulsification for cataracts.Methods 39 cases (39 eyes) with posterior capsule rupture in 825 patients (896 eyes)performed with phacoemulsification were retrospective analyzed.Results The posterior capsule in 39 cases (39 eyes) were ruptured (4.35％),including 4 cases in capsulorhexis,5 cases in hydrodisseetion,27 cases in the process of emulsification and 3 cases in the cortex extraction.After the treatment with IOL implantation,the visual acuity in 29 eyes was equal to or more than 0.3(74.36％ ) ; The corneal edema appeared in 12 eyes(30.77％ ),all of them recovered within a week.Conclusion Posterior capsule rupture is a familiar complication in phacoemulsification and happens in varial steps.Appropriate and timely intraoperative management will bring good visual acuity. Key words: Phacoemulsification; Posterior capsule rupture

Analysis and management of posterior capsule rupture in phacoemulsification

Objective To analyze the cause of the posterior capsule rupture in phacoemulsification and the management.Methods 35 phacoemulsification cataract eye capsule rupture occurred in 580 cases (640 eyes) were analyzed and summarized.Results In 35 cases capsule rupture,capsulorhexis (CCC)inappropriate was 3 cases (8.6％),water separation inappropriate three patients ( 8.6％ ),cuting nuclear pieces 20 patients (57.0％),and extracting cortical relevant 6 patients ( 17.2),implanting intraocular lens inadvertently 3 cases ( 8.6％ ).Conclusion Intraoperative posterior capsular rupture is a more familiar complication in phacoemulsification cataract extraction.Early detection,timely processing,can obtain good effect. Key words: Cataract; Phacoernulsification; The posterior capsule rupture; Processing measures

The cause and management of posterior capsule rupture in manual small incision cataract surgery in primary level hospital

Objective To study the causes and management of posterior capsule rupture (PCR) in manual small incision cataract surgery (MSICS). Methods The clinical cases of 75 eyes of PCR in 978 eyes undergoing MSICS were analysed. Results These 75 eyes all got IOLS,and the number of eyes which achieved a best corrected visual acuity of 0. 3 or more was 54 (72. 00% ). Conclusion Posterior capsule rupture which occurred in different stages of the operation was the commonest intra-operative complication in MSICS. The incidence of PCR can be decreased by careful operation and suitable management leads to satisfactory outcome. Key words: primary level hospital; cataract extraction, small incision; rupture, posterior capsule.

The causes and management of posterior capsule rupture in manual small incision cataract surgery

目的 探讨手法小切口白内障囊外摘出(MSICS)术中晶状体后囊破裂的原因及处理方法.方法回顾分析360眼手法小切口白内障囊外摘出联合后房型人工晶状体植入术的临床资料,对其中26眼术中后囊破裂的原因和处理进行探讨.结果术中全部植入人工晶状体,术后矫正视力≥0.3者22眼(84.62%),无严重并发症.结论晶状体后囊破裂为手法小切口白内障囊外摘出联合后房型人工晶状体植入术中最常见并发症,可发生于诸多步骤.谨慎操作,可降低其发生率;正确处理可以获得良好的手术效果。

Management of posterior capsule rupture during phacoemulsification using the dry technique

To manage posterior capsule rupture during phacoemulsification, we use a dry technique in which all procedures are performed without an irrigation/aspiration system. The dry technique is characterized by (1) continuous viscoelastic injection instead of fluid irrigation to maintain anterior chamber depth with the posterior capsule and vitreous located posteriorly and (2) static removal of most residual lens material by viscoexpression and/or manual small incision extracapsular cataract extraction without aspiration and dynamic water flow. In 16 cases of posterior capsule rupture managed using the dry technique, the residual nucleus and cortex were readily removed with minimum extension of the ruptured area and new vitreous loss. Although large amounts of viscoelastic material (mean 5.8 mL) were required, rapid and stable visual recovery was comparable to that in patients having uneventful surgery. The dry system is a safe and reliable technique for managing posterior capsule rupture during phacoemulsification.

Prevention and management of posterior capsule rupture.

To present the means and technique used in our Department for prevention and management of posterior capsule rupture during planned extracapsular cataract extraction. Prospective analysis of 550 extracapsular cataract operations from October 1993 to March 1994. Our technique (a slight modification of Blumenthal's technique) included a triplanar watertight small scleral incision, a relatively large continuous curvilinear capsulorhexis, or can-opener capsulotomy, nucleus hydrodissection and hydroexpression, use of an anterior chamber maintainer and residual cortex removal through a 10 o'clock side-port corneal incision. Best corrected postoperative visual acuity ranged from 7-10/10 in 93.45% of our cases. Posterior capsule rupture with or without vitreous loss occurred in 1.63% and 2.72% of the cases, respectively. These rates are much lower than those, observed, when we used the sclerocorneal incision and nucleus extraction with external pressure. The combination of a triplanar watertight small scleral incision. A relatively large continuous curvilinear capsulorhexis, an anterior chamber maintainer and residual cortex aspiration through the 10 o'clock side-port corneal incision greatly reduced the posterior capsule rupture rate.

Vitreous loss in posterior chamber lens implantation

Management of posterior capsule rupture and vitreous loss associated with intraocular lens implantation is described and the results of the procedure statistically analyzed. Vitreous loss occurred in 18 (4.3%) of the 416 eyes treated during a one-year period. Of these 18 eyes, 11 received posterior chamber lenses and seven received anterior chamber lenses; all lenses remained adequately fixated. The visual acuity, incidence of postoperative complications, and endothelial cell loss were not significantly different in the eyes that had posterior capsule rupture and vitreous loss and in the control eyes. Although posterior chamber lens implantation is not necessarily contraindicated in eyes with vitreous loss, instances of high endothelial cell loss suggest the need for greater attention to the endothelial cells during vitrectomy.