Capsulotomy tag (right of picture) and bridge (left of picture)
Anterior radial tear
Anterior capsule rip extending posteriorly with the resultant posterior capsule rupture
Intralenticular gas bubbles
White rim of cortex seen
Capsulotomy and hydrodissection are the main steps in FLACS that can give rise to a posterior capsule rupture. In circumstances where the PCR is due to an extension of an anterior capsule rip, premium IOLs which require good capsule and bag stability may not be safely implanted. There is a learning curve for FLACS. Being aware of the potential problems that can arise during FLACS that may lead to PCR and knowing how to circumvent these problems will allow the surgeon to provide better visual outcomes for the patient.
Talamo JH, Gooding P, Angeley D, Culbertson WW, Schuele G, Andersen D, Marcellino G, Essock-Burns E, Batlle J, Feliz R, Friedman NJ, Palanker D. Optical patient interface in femtosecond laser-assisted cataract surgery: contact corneal applanation versus liquid immersion. J Cataract Refract Surg. 2013;39:501–10.CrossRefPubMed