Appropriate OVD Strategy to Optimize Outcomes in Posterior Capsular Rent

Perhaps the greatest fear of cataract surgeons is that of suddenly noticing a posterior capsular rent in what hitherto seemed to be a perfect “refractive” cataract surgical procedure. “Refractive,” because today all cataract surgeries aim to correct the patients’ underlying refractive errors, whether they are planned as clear lens extractions or procedures to restore functional vision for disabled patients with bilateral dense brunescent or mature cataracts. Since the first ultrasonic biometers became available in the early 1980s, we have progressively refined our “standard” techniques to enable ophthalmic surgeons to ever more accurately enhance refractive results from cataract surgery. We have evolved to have extremely high expectations, perhaps the highest of any medical or surgical procedure currently performed. We regularly hear our patients say that they see better after our surgery than they ever have before. Ultrahigh expectations contribute to the surgeon’s already high anxiety about increased risk for complications when a capsular rent appears, often bordering on panic, especially now that capsular tears are becoming much less common, approaching 1 % of cases or less.