Anatomical Barrier for Anterior and Posterior Capsular Tear Extension

Lim, Seung Jeong; Lee, Jae Bum; Kim, Hong Bok

Abstract

We examined the anatomical barrier for both anterior capsular tear extension and posterior capsular rupture extension which are the most serious intraoperative complications during cataract surgery, using 28 human eyes obtained postmortem. An experimental radial tear, about 1.0 mm in size, was created on the 5.0 mm capsulorhexis margin in the 1st group(7 eyes). Lens nucleus was removed mechanically with hydrodissection and viscoexpression technique. Radial tear extension did not extend over the lens equator in six eyes, and in one eye stopped in front of Wieger's ligament. In the 2nd group(7 eyes), after making zonular rupture around 90 degrees, same procedures were performed. Radial tear extension stopped at the equator in four eyes, and in three eyes stopped in front of Wiegel's ligament. In the 3rd group(7 eyes), we performed capsulorhexis and routine phacoemulsification for lens nucleus and cortex removal. Then we created only a posterior capsule rupture with intact anterior hyaloid membrane and vitreous pressure was increased. Posterior capsular rupture extension stopped in front of Wieger's ligament in all seven eyes. In the 4th group(7 eyes), after creating the rupture of the posterior capsule including anterior hyaloid membrane, intraocular lens was inserted into the empty capsular bag as a perpendicular direction to the axis of the tear. Posterior capsular rupture extension passed Wieger's ligament in only one eye, but did not reach equator or anterior capsule. In this study, we found that zonules, equator portion of the capsular bag and Wieger's ligament act as anatomical barriers for anterior capsular teal extension as well as for posterior capsular rupture extension.