Posterior Capsulorhexis as a Preventive Strategy: A Case of Bilateral Congenital Cataract With Divergent Outcomes

Posterior capsule opacification (PCO) is a common delayed complication of cataract surgery, particularly in younger patients and those receiving multifocal intraocular lenses (IOLs). Intraoperative posterior capsulorhexis has been proposed as a preventive technique, but its use in adult cataracts is less documented. A 27-year-old patient presented with bilateral congenital posterior subcapsular cataracts, high myopia, and astigmatism. Comprehensive preoperative examination, including visual function and retinal imaging, was performed. The patient underwent phacoemulsification with toric multifocal IOL implantation in both eyes. Intraoperative posterior capsulorhexis was performed in the right eye, while the left eye underwent standard surgery without capsulorhexis. One month postoperatively, both eyes achieved excellent visual acuity (OD: 1.0, OS: 1.0) and satisfactory refractive outcomes. Four months postoperatively, the left eye developed PCO, necessitating Nd:YAG laser capsulotomy, after which the patient experienced retinal detachment requiring vitrectomy. Vision in the left eye decreased to 0.6. The right eye, which underwent posterior capsulorhexis, remained free of PCO and complications, with stable visual acuity of 1.0. This case highlights the potential benefit of intraoperative posterior capsulorhexis in preventing PCO and secondary complications in high-risk adult patients undergoing cataract surgery with multifocal IOLs. Posterior capsulorhexis may reduce the need for Nd:YAG laser capsulotomy and its associated risks, particularly in young adults with congenital cataracts and high myopia.