Visual and refractive outcomes following management of anterior capsular tears with a capsulorrhexis relaxing incision

Abstract Objective To evaluate the refractive outcomes after anterior capsular tear (ACT). Design Retrospective case–control study. Participants After ethics approval, the surgical operative records of 4301 consecutive patients undergoing cataract surgery by a single surgeon were reviewed for cases of ACT. Methods All ACTs were managed using a balancing incision of the capsulorrhexis margin 180 degrees away from the tear. If the patient’s other eye had undergone cataract surgery by the same surgeon, it was included as a control. Results Fifty-one eyes of 51 patients were complicated by ACT (incidence = 1.2%). The mean age of patients in the study was 64.2 ± 12.1 years. Of the 51 patients with ACT, 34 underwent contralateral surgery. These eyes were used as the control group. There was no significant difference in preoperative visual acuity ( p = 0.683) or proportion of eyes that received in-the-bag intraocular lens placement ( p = 0.347) between groups (ACT = 92.2%; control = 97.1%). In 3 ACT eyes, the tear extended into the posterior capsule (5.9%), and although this did not occur in control eyes, this difference was not statistically significant ( p = 0.150). There was no difference in best-corrected final logMAR visual acuity between groups ( p = 0.424) or postoperative spherical equivalent between ACT (−0.23 ± 1.2D) and control (−0.15 ± 0.62D) eyes ( p = 0.985). Conclusions Cataract extraction complicated by ACT can result in equivalent visual and refractive outcomes as in uncomplicated surgery. The technique used in this study prevented extension of ACT to the posterior capsule in 94.1% of cases.