Outcomes and Complications of Phacoemulsification Cataract Surgery Complicated by Anterior Capsule Tear

Abstract

Abstract Purpose: This study aims to present the outcomes and complications associated with phacoemulsification cataract surgery complicated by anterior capsule tears. Methods: In this prospective study, we enrolled patients who underwent phacoemulsification cataract surgery with anterior capsule tears. We documented demographic, biometric, intraoperative, and postoperative data. The main assessed outcomes included the stage of anterior tear identification, intraoperative capsule complication rates, intraocular lens (IOL) placement and design, visual outcomes, surgically induced astigmatism (SIA), and the incidence of postoperative complications. Results: We enrolled 21 eyes of 21 patients who experienced anterior capsule tears during phacoemulsification cataract surgery. Anterior capsule tears were identified during phacoemulsification in 11 eyes (52.4%), during capsulorhexis in 9 eyes (42.9%), and during irrigation/aspiration in 1 eye (4.7%). Among the eyes, tears extended to the posterior capsule in 8 cases (38.1%), resulting in vitreous loss. Endocapsular fixation of a 1-piece acrylic IOL was achieved in 4 eyes (19.0%), while 4 eyes (19.0%) required implantation of a 3-piece acrylic IOL in the ciliary sulcus. Postoperative best-corrected visual acuity at 12 months significantly improved compared to baseline (P < 0.001). The overall SIA at 12 months was not statistically significant (P = 0.098). During the 12-month postoperative follow-up, cystoid macular edema and retinal detachment were observed in 2 eyes (9.5%) and 1 eye (4.7%), respectively. Conclusion: Anterior capsule tears during cataract surgery, while not a major complication by themselves, can lead to complications when they extend to the posterior capsule. These subsequent complications can impact surgical outcomes and increase the risk of postoperative morbidities.