Case report: Spontaneous Expansion of an Isolated Posterior Capsule Rupture

Case report: Spontaneous Expansion of an Isolated Posterior Capsule Rupture | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Case report: Spontaneous Expansion of an Isolated Posterior Capsule Rupture Weifang Ma, Li Zhou, Yuchuan Chen, Yali Liu, Yu Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4457571/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Isolated posterior capsule rupture following blunt trauma has been seldom reported. Even rarer are cases of blunt trauma wherein spontaneous enlargement of isolated posterior capsule rupture occurs before surgery. In this report, we present a case involving a child with spontaneous dilation of isolated posterior capsule rupture while awaiting surgery, providing valuable insights for clinicians in determining the optimal timing for the operation. Abstract We report a case involving the spontaneous expansion following isolated posterior capsule rupture during follow-up after blunt trauma. Although the size of the posterior capsule rupture increased, an intraocular lens was successfully implanted in the capsular bag following conventional phacoemulsification. Importantly, the fibrotic posterior capsule did not undergo further tearing during the operation, and the vitreous body remained intact without anterior segment vitrectomy. Conclusions Our findings suggest that waiting for posterior capsule fibrosis may prevent further tearing of the posterior capsule during surgery, despite potential variations in the size of the isolated posterior capsule rupture during the waiting period. isolated posterior capsule rupture blunt trauma fibrosis spontaneous expansion Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background While isolated posterior capsule rupture (PCR) is a rare clinical occurrence, proposed mechanisms shed light on its origins. The posterior capsule is believed to be less resistant to traumatic stress induced by distortive forces from the crystalline lens structure. Zonular tension pulls the posterior capsule centrifugally, leading to a blow-out rupture of the posterior capsule [ 1 ] . The border of this rupture is determined by the adherence of Wieger's ligament in the young [ 2 ] . A negative relationship was noted between the maximum zonular tolerated stretch and age [ 3 ] . Instantaneous high pressure are common during sudden high-speed impacts. These theories may explain why young patients with isolated PCR do not typically experience concomitant lens dislocation. BUT there is currently no standardized surgical time frame for traumatic PCR. Isolated PCR typically undergoes fibrosis within 6 weeks, reducing the likelihood of intraoperative rupture enlargement [ 4 , 5 ] . Delayed surgery may be advantageous for intraocular lens(IOL)implantation into the capsule bag. However, changes in the tear dimensions may occur with delayed surgery [ 1 , 6 ] . Given the limited number of patients with isolated PCR, the speculation about rupture enlargement caused by delayed surgery requires confirmation. Confirming this speculation is crucial for clinicians to determine optimal surgical or follow-up times for similar cases. We present a case involving a child with spontaneous dilation of PCR while awaiting surgery, providing valuable insights for clinicians in determining the optimal timing for the operation. Case presentation A 6-year-old boy was diagnosed with a posterior capsular tear during a follow-up examination for amblyopia treatment. Three months ago, the best corrected visual acuity (BCVA) of his left eye was 20/20 with + 1.25DS/−1.75DC at 40° correction. The patient recalled being struck in the left eyelid by fragments from a firecracker explosion but could not recall the specific time of the injury. The patient has no history of examination and treatment in other medical institutions, denying that there are similar cases in the family. Examinations revealed a clear cornea, quiet anterior chamber, and brisk pupil reactions. The anterior capsule remained intact. A localized posterior capsular cataract, accompanied by hydration of the surrounding cortex, was identified. The length of spindle-shaped PCR was about 1.5 mm. (Fig. 1 ). The uncorrected visual acuity (UCVA) was 20/80 and couldn’t be corrected. Computerized optometry revealed severe astigmatism of the injured eye. K readings didn’t indicate significant corneal astigmatism. There is no special abnormality in the right eye, with a BCVA of 20/20. The patient postponed the surgery for 3 months due to personal reasons. The length of the PCR had increased to approximately 5 mm, and the area of posterior subcapsular cortical opacity had expanded one day before surgery (Fig. 2 ). Additionally, the BCVA had decreased to 20/200. It is expected that if no surgical treatment measures are taken, the visual acuity will further decline and affect the life of the patient, especially the visual development of children. With the consent of the child's guardian, surgery was performed. A self-sealing 2.8mm clear corneal tunnel incision was created. A 5.5mm capsulorhexis was performed under the protec-tion of an ophthalmic viscosurgical device. Hydrodissection was omitted, and only hydrodelineation was conducted using a small quantity of balanced salt solution. Controlled aspiration of the cortex was carried out at a low bottle height and a high vacuum setting. The PCR remained unaltered and the vitreous face remained intact after cortex aspiration (Fig. 3 ). A foldable IOL was implanted into the bag (Fig. 4 ). The haptics were positioned perpendicular to the vertical axis of the PCR. On the third postoperative day, the UCVA was 20/40, the BCVA was 20/25 (+ 3.0DS/−2.25DC at 40° correction), the IOL was well-positioned, and the anterior chamber was quiet (Fig. 5 ). One month after surgery, the UCVA was 20/80, the BCVA was 20/32 and the intraocular pressure was 13 mmHg. Three month after surgery, the UCVA was 20/50, the BCVA was 20/25 (+ 2.75DS/−1.50DC at 32° correction) and the intraocular pressure was 18 mmHg. The child did not complain of any postoperative visual discomfort and the guardian was satisfied with the outcome of the operation. Discussion and Conclusions The case of isolated PCR resulting from blunt contusion that we reported did not involve lens dislocation, iris injury, or retinal injury, aligning with previous observations and inferences. The significance of our case lies in being the first to observe a change in the size of isolated posterior capsule rupture. Our case exhibited an increase in rupture size 3 months after the initial observation, supporting previous speculation that the size of the rupture may increase during fibrosis. Despite the expansion of PCR before surgery, successful implantation of the IOL into the capsule was achieved in our case. We posit that although the rupture size may increase during fibrosis, the probability of enlarging the posterior capsule rupture during surgery decreases after fibrosis. It cannot be ruled out that during the waiting period, the expansion of the rupture may hinder IOL implantation into the capsule, but no clinical examples have been observed. While delayed surgery for isolated posterior capsule rupture (PCR) carries inherent risks, the fibrotic nature of the posterior capsule resulting from delayed intervention can serve as a protective factor. This fibrosis has the potential to prevent intraoperative posterior capsule tearing and enlargement, thereby minimizing the risk of intraoperative vitreous detachment. Additionally, the fibrotic changes may increase the likelihood of successfully implanting IOL within the capsule. The primary controversy surrounding the selection of surgical methods centers on how to prevent the exacerbation of intraoperative posterior capsule rupture (PCR) and manage vitreous issues. In the past, bimanual irrigation/aspiration (I/A) through two paracentesis stab incisions was employed for children with preexisting posterior capsule defects [ 7 ] . Another safe approach involves the removal of crystalline cortex using a high vacuum and low flow rate mode of phacoemulsification [ 8 , 9 ] . In our case, the latter method was utilized, aligning with the preferences of the cataract surgeon. Anterior vitrectomy is typically performed intraoperatively in cases of isolated PCR when vitreous prolapses into the anterior chamber [ 7 – 9 ] . However, cases with PCR but intact vitreous may not necessitate anterior vitrectomy [ 6 , 10 ] . In our case, the vitreous body remained intact and did not prolapse into the capsular bag. Currently, the mechanism underlying the spontaneous increase in the size of isolated PCR is unclear. Hydration of crystals and swelling cataracts have been proposed as factors contributing to the enlargement of posterior capsule ruptures [ 1 ] . In the case we reported, there was no additional injury during the referral process, and the lens opacity was confined to the posterior capsule without an intumescent cataract. When the integrity of the crystalline lens is compromised, lens material may protrude through the PCR [ 11 ] . Local herniation and hydration of the crystalline cortex may exert compression on the fissure. Additionally, the shape of the ruptured posterior capsule is spindle-shaped, suggesting the possibility of radial tearing. Previously, isolated PCR was described as having an oval shape [ 9 ] . Describing it as spindle-shaped may provide a more accurate characterization. In summary, waiting for posterior capsule fibrosis may prevent further tearing of the posterior capsule during surgery for isolated PCR cases, despite potential variations in the size of the PCR during the waiting period. Abbreviations PCR posterior capsule rupture IOL intraocular lens BCVA best corrected visual acuity UCVA uncorrected visual acuity Declarations Authors’ contributions WM follows up the patient, wrote this article and made revisions . LZ discovered changes in the size of posterior capsule rupture during patient follow-up,wrote this article and made revisions. YC :performed surgery on the patient and pointed out that it was a special case of patient. YL proposed revision suggestions . All authors read and approved the final manuscript. Funding No funding. Availability of data and materials The data used/analysed in the current study are available from the corresponding author on reasonable request. Consent for publication Verbal and written informed consent gained by participant’s parent (participant under 16 years). Signed institutional consent form available on request. Competing interests The authors declare that they have no competing interests. References Pavlovic S. Epilenticular intraocular lens implantation in traumatic cataract with a ruptured posterior capsule. Am J Ophthalmol. 2000;130(3):352–3. Campanella PC, Aminlari A, DeMaio R. Traumatic cataract and Wieger's ligament. Ophthalmic Surg Lasers. 1997;28(5):422–3. Saber HR, Butler TJ, Cottrell DG. Resistance of the human posterior lens capsule and zonules to disruption. J Cataract Refract Surg. 1998;24(4):536–42. Vajpayee RB, Angra SK, Honavar SG. etc. Pre-existing posterior capsule breaks from perforating ocular injuries. J Cataract Refract Surg. 1994;20(3):291–4. Saika S, Kin K, Ohmi S. etc. Posterior capsule rupture by blunt ocular trauma. J Cataract Refract Surg. 1997;23(1):139–40. Grewal D, Jain R, Brar G. etc. Scheimpflug imaging of pediatric posterior capsule rupture. Indian J Ophthalmol. 2009;57(3):236–8. Vasavada AR, Praveen MR, Nath V. etc. Diagnosis and management of congenital cataract with preexisting posterior capsule defect. J Cataract Refract Surg. 2004;30(2):403–8. Pushker N, Sony P, Khokhar S. etc. Implantation of foldable intraocular lens with anterior optic capture in isolated posterior capsule rupture. J Cataract Refract Surg. 2005;31(7):1457. Kumar D, Srinivasaraghavan P, Agarwal A. etc. Extended focal length intraocular lens implantation in posttraumatic posterior capsular rupture. Indian J Ophthalmol.2018;66(5):701-04. Akura JHS, Kaneda S, Ishihara M. etc. Management of posterior capsule tear during phacoemulsification using the dry technique. J Cataract Refract Surg. 2001;27:982–9. Grewal DS, Jain R, Brar GS. etc. Posterior capsule rupture following closed globe injury: Scheimpflug imaging, pathogenesis, and management. Eur J Ophthalmol. 2008;18(3):453–5. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4457571","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":309376585,"identity":"de4ff850-bc6a-4429-acbc-f108bd28ec1f","order_by":0,"name":"Weifang Ma","email":"","orcid":"","institution":"West China Forth Hospital , Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Weifang","middleName":"","lastName":"Ma","suffix":""},{"id":309376586,"identity":"a14f5857-697e-45b2-881e-bcd32317ae6d","order_by":1,"name":"Li Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIie3PsQrCMBCA4ZSDTFe6SYpCXyEiiEPBV4kUOjk4OgoVfYWKPoSj45VCp4KroIMgOBdcRQyIk9LGzSE/3HYfxzFms/1jQs9ZPtADIKqmpkRJ6vhLPsrS0pgwCuUee7k7NxDBOimEmpyQ5ViRO2OB16J64myKWCh5RSdxt+TvWHe1VvUExLivCSCAJt1S/3VsIPxNOOCZRgsDgi+SIwIyykyIEHE0UDJGAVxms1I0/xKkUXao7uFwuM8vt/s0DLx2A/m4+tu6zWaz2b73BO/tQSoAFuD/AAAAAElFTkSuQmCC","orcid":"","institution":"West China Forth Hospital , Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Li","middleName":"","lastName":"Zhou","suffix":""},{"id":309376587,"identity":"ea2a3e0a-f8fb-476a-9e54-4f456cc198e7","order_by":2,"name":"Yuchuan Chen","email":"","orcid":"","institution":"West China Forth Hospital , Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Yuchuan","middleName":"","lastName":"Chen","suffix":""},{"id":309376588,"identity":"6cbb8180-8b13-4afe-b8e8-44bea2b07bd9","order_by":3,"name":"Yali Liu","email":"","orcid":"","institution":"West China Forth Hospital , Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Yali","middleName":"","lastName":"Liu","suffix":""},{"id":309376589,"identity":"ddfd2dab-a217-40be-a4d1-fc0e15caf9fc","order_by":4,"name":"Yu Li","email":"","orcid":"","institution":"West China Forth Hospital , Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2024-05-22 01:53:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4457571/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4457571/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58077072,"identity":"5e53b93f-c569-4643-9074-09fe4c127340","added_by":"auto","created_at":"2024-06-10 22:23:45","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":690406,"visible":true,"origin":"","legend":"\u003cp\u003eSlitlamp backlighting image showing a spindle-shaped PCR and local opacity under the posterior capsule\u003c/p\u003e","description":"","filename":"Fig.1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4457571/v1/e369a7011bb38fe3a52c2a79.jpeg"},{"id":58077247,"identity":"69c16200-dcd5-47f2-a036-981f43be7130","added_by":"auto","created_at":"2024-06-10 22:31:45","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":977616,"visible":true,"origin":"","legend":"\u003cp\u003eDiffuse image showing the expansion of the PCR and opacification\u003c/p\u003e","description":"","filename":"Fig.2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4457571/v1/e91e3f99c77e68e613eb3836.jpeg"},{"id":58077068,"identity":"7786b758-37da-4df2-9fda-614a43f4d27c","added_by":"auto","created_at":"2024-06-10 22:23:45","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":218863,"visible":true,"origin":"","legend":"\u003cp\u003eThe posterior capsule breach was not enlarged after the cortex was aspirated\u003c/p\u003e","description":"","filename":"Fig.3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4457571/v1/0e24f0d80594e67b5ce9d85e.jpeg"},{"id":58077070,"identity":"6a236307-4d84-4adb-8031-74e21423b3ca","added_by":"auto","created_at":"2024-06-10 22:23:45","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":246302,"visible":true,"origin":"","legend":"\u003cp\u003eThe IOL was implanted in the bag\u003c/p\u003e","description":"","filename":"Fig.4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4457571/v1/3e48774b0dc64980b996182d.jpeg"},{"id":58077071,"identity":"c4cfdaec-4cef-4fca-addd-ffcd6cf8a980","added_by":"auto","created_at":"2024-06-10 22:23:45","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1329312,"visible":true,"origin":"","legend":"\u003cp\u003e3 days after surgery, the IOL was well positioned\u003c/p\u003e","description":"","filename":"Fig.5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4457571/v1/440fb2a45f625eaba7fdab66.jpeg"},{"id":63095296,"identity":"8e1da53b-be2b-4904-b0b8-640e20a23b15","added_by":"auto","created_at":"2024-08-23 05:29:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3674271,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4457571/v1/abefe07f-a365-490a-ad8d-56ae35aa61c6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Case report: Spontaneous Expansion of an Isolated Posterior Capsule Rupture","fulltext":[{"header":"Background","content":"\u003cp\u003eWhile isolated posterior capsule rupture (PCR) is a rare clinical occurrence, proposed mechanisms shed light on its origins. The posterior capsule is believed to be less resistant to traumatic stress induced by distortive forces from the crystalline lens structure. Zonular tension pulls the posterior capsule centrifugally, leading to a blow-out rupture of the posterior capsule \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. The border of this rupture is determined by the adherence of Wieger's ligament in the young \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. A negative relationship was noted between the maximum zonular tolerated stretch and age \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Instantaneous high pressure are common during sudden high-speed impacts. These theories may explain why young patients with isolated PCR do not typically experience concomitant lens dislocation. BUT there is currently no standardized surgical time frame for traumatic PCR. Isolated PCR typically undergoes fibrosis within 6 weeks, reducing the likelihood of intraoperative rupture enlargement \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Delayed surgery may be advantageous for intraocular lens(IOL)implantation into the capsule bag. However, changes in the tear dimensions may occur with delayed surgery \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Given the limited number of patients with isolated PCR, the speculation about rupture enlargement caused by delayed surgery requires confirmation. Confirming this speculation is crucial for clinicians to determine optimal surgical or follow-up times for similar cases. We present a case involving a child with spontaneous dilation of PCR while awaiting surgery, providing valuable insights for clinicians in determining the optimal timing for the operation.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 6-year-old boy was diagnosed with a posterior capsular tear during a follow-up examination for amblyopia treatment. Three months ago, the best corrected visual acuity (BCVA) of his left eye was 20/20 with +\u0026thinsp;1.25DS/\u0026minus;1.75DC at 40\u0026deg; correction. The patient recalled being struck in the left eyelid by fragments from a firecracker explosion but could not recall the specific time of the injury. The patient has no history of examination and treatment in other medical institutions, denying that there are similar cases in the family. Examinations revealed a clear cornea, quiet anterior chamber, and brisk pupil reactions. The anterior capsule remained intact.\u003c/p\u003e \u003cp\u003eA localized posterior capsular cataract, accompanied by hydration of the surrounding cortex, was identified. The length of spindle-shaped PCR was about 1.5 mm. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The uncorrected visual acuity (UCVA) was 20/80 and couldn\u0026rsquo;t be corrected. Computerized optometry revealed severe astigmatism of the injured eye. K readings didn\u0026rsquo;t indicate significant corneal astigmatism. There is no special abnormality in the right eye, with a BCVA of 20/20. The patient postponed the surgery for 3 months due to personal reasons. The length of the PCR had increased to approximately 5 mm, and the area of posterior subcapsular cortical opacity had expanded one day before surgery (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Additionally, the BCVA had decreased to 20/200. It is expected that if no surgical treatment measures are taken, the visual acuity will further decline and affect the life of the patient, especially the visual development of children.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWith the consent of the child's guardian, surgery was performed. A self-sealing 2.8mm clear corneal tunnel incision was created. A 5.5mm capsulorhexis was performed under the protec-tion of an ophthalmic viscosurgical device. Hydrodissection was omitted, and only hydrodelineation was conducted using a small quantity of balanced salt solution. Controlled aspiration of the cortex was carried out at a low bottle height and a high vacuum setting. The PCR remained unaltered and the vitreous face remained intact after cortex aspiration (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). A foldable IOL was implanted into the bag (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The haptics were positioned perpendicular to the vertical axis of the PCR. On the third postoperative day, the UCVA was 20/40, the BCVA was 20/25 (+\u0026thinsp;3.0DS/\u0026minus;2.25DC at 40\u0026deg; correction), the IOL was well-positioned, and the anterior chamber was quiet (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). One month after surgery, the UCVA was 20/80, the BCVA was 20/32 and the intraocular pressure was 13 mmHg. Three month after surgery, the UCVA was 20/50, the BCVA was 20/25 (+\u0026thinsp;2.75DS/\u0026minus;1.50DC at 32\u0026deg; correction) and the intraocular pressure was 18 mmHg. The child did not complain of any postoperative visual discomfort and the guardian was satisfied with the outcome of the operation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003eThe case of isolated PCR resulting from blunt contusion that we reported did not involve lens dislocation, iris injury, or retinal injury, aligning with previous observations and inferences. The significance of our case lies in being the first to observe a change in the size of isolated posterior capsule rupture. Our case exhibited an increase in rupture size 3 months after the initial observation, supporting previous speculation that the size of the rupture may increase during fibrosis. Despite the expansion of PCR before surgery, successful implantation of the IOL into the capsule was achieved in our case. We posit that although the rupture size may increase during fibrosis, the probability of enlarging the posterior capsule rupture during surgery decreases after fibrosis. It cannot be ruled out that during the waiting period, the expansion of the rupture may hinder IOL implantation into the capsule, but no clinical examples have been observed. While delayed surgery for isolated posterior capsule rupture (PCR) carries inherent risks, the fibrotic nature of the posterior capsule resulting from delayed intervention can serve as a protective factor. This fibrosis has the potential to prevent intraoperative posterior capsule tearing and enlargement, thereby minimizing the risk of intraoperative vitreous detachment. Additionally, the fibrotic changes may increase the likelihood of successfully implanting IOL within the capsule.\u003c/p\u003e \u003cp\u003eThe primary controversy surrounding the selection of surgical methods centers on how to prevent the exacerbation of intraoperative posterior capsule rupture (PCR) and manage vitreous issues. In the past, bimanual irrigation/aspiration (I/A) through two paracentesis stab incisions was employed for children with preexisting posterior capsule defects \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Another safe approach involves the removal of crystalline cortex using a high vacuum and low flow rate mode of phacoemulsification \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. In our case, the latter method was utilized, aligning with the preferences of the cataract surgeon. Anterior vitrectomy is typically performed intraoperatively in cases of isolated PCR when vitreous prolapses into the anterior chamber \u003csup\u003e[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. However, cases with PCR but intact vitreous may not necessitate anterior vitrectomy \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. In our case, the vitreous body remained intact and did not prolapse into the capsular bag.\u003c/p\u003e \u003cp\u003eCurrently, the mechanism underlying the spontaneous increase in the size of isolated PCR is unclear. Hydration of crystals and swelling cataracts have been proposed as factors contributing to the enlargement of posterior capsule ruptures \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. In the case we reported, there was no additional injury during the referral process, and the lens opacity was confined to the posterior capsule without an intumescent cataract. When the integrity of the crystalline lens is compromised, lens material may protrude through the PCR \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Local herniation and hydration of the crystalline cortex may exert compression on the fissure. Additionally, the shape of the ruptured posterior capsule is spindle-shaped, suggesting the possibility of radial tearing. Previously, isolated PCR was described as having an oval shape \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Describing it as spindle-shaped may provide a more accurate characterization.\u003c/p\u003e \u003cp\u003eIn summary, waiting for posterior capsule fibrosis may prevent further tearing of the posterior capsule during surgery for isolated PCR cases, despite potential variations in the size of the PCR during the waiting period.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePCR \u0026nbsp;posterior capsule rupture\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;IOL \u0026nbsp;intraocular lens\u003c/p\u003e\n\u003cp\u003eBCVA \u0026nbsp;best corrected visual acuity\u003c/p\u003e\n\u003cp\u003eUCVA uncorrected visual acuity\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWM \u0026nbsp;follows up the patient, wrote this article and made revisions .\u003c/p\u003e\n\u003cp\u003eLZ discovered changes in the size of posterior capsule rupture during patient follow-up,wrote this article and made revisions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eYC :performed surgery on the patient and pointed out that it was a special case of patient.\u003c/p\u003e\n\u003cp\u003eYL proposed revision suggestions\u0026nbsp;.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eFunding No funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data used/analysed in the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVerbal and written informed consent gained by participant\u0026rsquo;s parent (participant under 16 years). Signed institutional consent form available on request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePavlovic S. Epilenticular intraocular lens implantation in traumatic cataract with a ruptured posterior capsule. Am J Ophthalmol. 2000;130(3):352\u0026ndash;3.\u003c/li\u003e\n\u003cli\u003eCampanella PC, Aminlari A, DeMaio R. Traumatic cataract and Wieger's ligament. Ophthalmic Surg Lasers. 1997;28(5):422\u0026ndash;3.\u003c/li\u003e\n\u003cli\u003eSaber HR, Butler TJ, Cottrell DG. Resistance of the human posterior lens capsule and zonules to disruption. J Cataract Refract Surg. 1998;24(4):536\u0026ndash;42.\u003c/li\u003e\n\u003cli\u003eVajpayee RB, Angra SK, Honavar SG. etc. Pre-existing posterior capsule breaks from perforating ocular injuries. J Cataract Refract Surg. 1994;20(3):291\u0026ndash;4.\u003c/li\u003e\n\u003cli\u003eSaika S, Kin K, Ohmi S. etc. Posterior capsule rupture by blunt ocular trauma. J Cataract Refract Surg. 1997;23(1):139\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003eGrewal D, Jain R, Brar G. etc. Scheimpflug imaging of pediatric posterior capsule rupture. Indian J Ophthalmol. 2009;57(3):236\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eVasavada AR, Praveen MR, Nath V. etc. Diagnosis and management of congenital cataract with preexisting posterior capsule defect. J Cataract Refract Surg. 2004;30(2):403\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003ePushker N, Sony P, Khokhar S. etc. Implantation of foldable intraocular lens with anterior optic capture in isolated posterior capsule rupture. J Cataract Refract Surg. 2005;31(7):1457.\u003c/li\u003e\n\u003cli\u003eKumar D, Srinivasaraghavan P, Agarwal A. etc. Extended focal length intraocular lens implantation in posttraumatic posterior capsular rupture. Indian J Ophthalmol.2018;66(5):701-04.\u003c/li\u003e\n\u003cli\u003eAkura JHS, Kaneda S, Ishihara M. etc. Management of posterior capsule tear during phacoemulsification using the dry technique. J Cataract Refract Surg. 2001;27:982\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eGrewal DS, Jain R, Brar GS. etc. Posterior capsule rupture following closed globe injury: Scheimpflug imaging, pathogenesis, and management. Eur J Ophthalmol. \u0026nbsp;2008;18(3):453\u0026ndash;5.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"isolated posterior capsule rupture, blunt trauma, fibrosis, spontaneous expansion","lastPublishedDoi":"10.21203/rs.3.rs-4457571/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4457571/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eIsolated posterior capsule rupture following blunt trauma has been seldom reported. Even rarer are cases of blunt trauma wherein spontaneous enlargement of isolated posterior capsule rupture occurs before surgery. In this report, we present a case involving a child with spontaneous dilation of isolated posterior capsule rupture while awaiting surgery, providing valuable insights for clinicians in determining the optimal timing for the operation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbstract\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe report a case involving the spontaneous expansion following isolated posterior capsule rupture during follow-up after blunt trauma. Although the size of the posterior capsule rupture increased, an intraocular lens was successfully implanted in the capsular bag following conventional phacoemulsification. Importantly, the fibrotic posterior capsule did not undergo further tearing during the operation, and the vitreous body remained intact without anterior segment vitrectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur findings suggest that waiting for posterior capsule fibrosis may prevent further tearing of the posterior capsule during surgery, despite potential variations in the size of the isolated posterior capsule rupture during the waiting period.\u003c/p\u003e","manuscriptTitle":"Case report: Spontaneous Expansion of an Isolated Posterior Capsule Rupture","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-10 22:23:40","doi":"10.21203/rs.3.rs-4457571/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"81785dbe-7b73-4ee8-9641-3842188e9a48","owner":[],"postedDate":"June 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-23T02:21:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-10 22:23:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4457571","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4457571","identity":"rs-4457571","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}