Posterior capsule rupture with FLACS due to erroneous interpretation of a high OCT intensity area in anterior vitreous

PURPOSE: We describe a case of posterior capsule rupture during femtosecond laser-assisted cataract surgery (FLACS) due to direct exposure of the posterior capsule to the laser beam. OBSERVATIONS: A 47-year-old man underwent FLACS for anterior capsule opacity. The CATALYS® system automatically detected the posterior capsule from the optical coherence tomography (OCT) images, after which the operator manually adjusted the line of posterior capsule. Femtosecond laser irradiation was presumed to be completed successfully. However, upon insertion of a phaco-tip, the diced nucleus of the lens dropped into the vitreous chamber. Reviewing intraoperative OCT images of the treatment summary to check the area irradiated by laser, an arc-shaped high-intensity area was observed behind the posterior capsule. This high-intensity was misinterpreted as the posterior capsule, which led to error in application of laser beam during procedure. CONCLUSIONS AND IMPORTANCE: Comparison of data acquired using different imaging modalities could enable correct identification of the posterior capsule.