Management of Posterior Capsular Rent in Cataract Surgery Patients at a Tertiary Hospital in India: A Retrospective Study.

Background: Cataracts are the primary cause of preventable blindness worldwide, especially in India. Various surgical procedures are available for treating cataracts. Nevertheless, extreme vigilance is required to avoid associated complications of surgical procedures such as posterior capsular rent (PCR), endophthalmitis, and nucleus drop.

Aim: To identify preoperative risk factors, intraoperative management, and postoperative outcomes in patients with PCR.

Methods: We conducted a retrospective observational study of patients operated on for cataracts by small-incision cataract surgery (SICS) or phacoemulsification from January 2018 to October 2023 at Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli, India. Records were collected, and 29 eyes of 29 patients who had had PCR during cataract surgery were evaluated for one month postoperatively. Wilcoxon signed-rank test was used for data analysis.

Results: The average age of patients with PCR was 67.8 years, and 55.17% were men. Sixty-nine percent of cases were of SICS, 31.03% of phacoemulsification, and PCR occurred in 51.7% of cases by an inexperienced surgeon. With PCR, risk factors such as corneal opacity (6.9%), pterygium (13.8%), shallow anterior chamber (3.45%), pseudo-exfoliation (13.8%), and small pupil (3.45%) were found to be linked. Management of PCR was performed in 29 cases. Anterior vitrectomy with intraocular lens (IOL) placement in the bag was done in 20.7% of cases (six cases), while anterior vitrectomy with IOL placement in the sulcus and pars plana vitrectomy (PPV) with IOL placement in the sulcus were performed in 3.45% of cases each (one case each). Anterior vitrectomy with iris-claw lens implantation was performed in 13.8% of cases (four cases). Additionally, 6.9% of cases (two cases) were left aphakic, which were later managed with PPV and scleral-fixated IOL (SFIOL) in one case and iris-claw lens implantation in the other. On post-op day 30, 20 patients (69%) achieved the best corrected visual acuity of 6/9-6/6, eight patients (27.6%) achieved 6/18-6/9, and one patient (3.45%) achieved 6/24. On comparison of preoperative vision with vision on day 30, the Z value was -4.418, and the P-value was less than 0.001, showing a statistically significant difference.

Conclusions: Our study showed that with proper intraoperative management and follow-up, PCR can be managed with excellent visual recovery (96.5% of our cases regained vision 6/9 and better).