IOL scaffold technique: A protective strategy to minimize posterior capsule rupture during phacoemulsification of hypermature cataract

Background: Phacoemulsification of hypermature cataracts, particularly white intumescent cataracts, can be challenging due to altered capsular characteristics, liquefied cortical matter, a dense nucleus and compromised intraoperative visibility. These factors may increase surgical complexity and the risk of posterior capsule rupture (PCR). Maintaining posterior capsular integrity during nucleus management is therefore essential.

Purpose: To demonstrate the application of an intraocular lens (IOL) scaffold technique as a protective strategy to minimize the risk of posterior capsule rupture during phacoemulsification of a hypermature cataract.

Case Presentation and Surgical Technique: A 60 years old male patient presenting with a white intumescent cataract underwent phacoemulsification in right eye. Following appropriate surgical preparation and management of the anterior capsule by two staged double capsulorhexis, nucleus removal was performed using a direct chop technique. After removal of the major portion of the nucleus, an IOL was carefully implanted into the capsular bag before emulsification of the final nuclear fragment. The IOL subsequently served as a mechanical scaffold, providing a protective barrier between the remaining nuclear fragment and the posterior capsule during the final stage of phacoemulsification. Careful surgical manipulation was maintained to preserve capsular integrity.

Results: The remaining nuclear fragment was successfully emulsified using the IOL scaffold technique. The posterior capsule remained intact, with no intraoperative posterior capsule rupture. The IOL was successfully positioned in the capsular bag. Postoperative visual acuity was 6/9.

Conclusion: IOL scaffolding may represent a useful adjunctive surgical strategy in selected challenging hypermature cataracts. By providing mechanical support during critical stages of cataract removal, this approach may help reduce the risk of posterior capsule rupture. Further clinical experience is required to establish its safety, reproducibility and broader applicability.

Keywords: Hypermature cataract; IOL scaffold; Phacoemulsification; Posterior capsule rupture; Direct chop.