Large air bubble in the Berger space during cataract surgery
A 41-year-old man with myopia in both eyes and a history of blunt trauma in his left eye was referred to the cataract department. He was diagnosed with a cataract; the corrected distance visual acuity was 18/20 in the right eye (refraction prescription, −4.5 −0.5 × 165), and visual acuity was hand motion in the left eye. The AC angle was assessed using ultrasound biomicroscope examination, and the result confirmed angle recession. The axial length (AL) and the anterior chamber depth (ACD) of the left eye measured using ultrasound technology were 24.19 mm and 3.95 mm, respectively. A target refraction of −4.00 diopters (D) was prepared for the left eye taking into consideration the refraction of his right eye. Phacoemulsification and hydrophobic acrylic IOL +22.5 D, (PY-60AD, HOYA) implantation was performed in the left eye. Correspondingly, the AL, ACD, and IOL power with the same target refraction for the right eye, measured using the IOLMaster 500 (v. 7.5, Carl Zeiss Meditec AG), was 24.39 mm, 3.90 mm, and 21.50 D, respectively.

During the entire surgical procedure, some unusual situations were encountered: (1) clear corneal incision: the eyeball was soft even with the ophthalmic viscosurgical device (OVD) injected in the AC prior to incision, and it was not easy to make the triplane incision; (2) capsulorhexis: the ACD was too deep and the lens/iris diaphragm moved posteriorly after OVD filling, which might indicate zonular weakness; (3) phacoemulsification: scattered small bubbles were located at the back of the posterior capsule after phacoemulsification cortical removal: during irrigation/aspiration, the air from the tube ran into the Berger space, possibly because of the relatively weak/defective zonular support and the relatively enlarged gap between the suspensory ligaments. After IOL implantation, it was decided to aspirate the air bubble in the Berger space using a 1 mL syringe (26-gauge), with the needle puncturing the bulging capsule through the main incision. Posterior capsule rupture (PCR) was detected during OVD removal after successful air bubble aspiration. The IOL was tilted and repositioned into the sulcus. The patient's corrected distance visual acuity was 20/20 in the left eye (refraction prescription, −2.75 −1.0 × 10) 1 week after the operation.