We determined the incidence in a developing nation of posterior capsule rupture during planned extracapsular cataract surgery and insertion of a posterior chamber intraocular lens. The results, in part, determine whether this complication limits the widespread utility of this procedure in developing nations. We retrospectively reviewed charts of all patients undergoing planned extracapsular cataract surgery during a 6-month period; all patients received surgery as inpatients at the Aravind Eye Hospital, Madurai, India, and all were southern Indians. We tried to exclude most patients with prior ocular diseases associated with loss of zonular or posterior capsule integrity. One eye of all eligible patients was included. Extra-capsular cataract surgery was performed using manual irrigation and aspiration with the insertion of a posterior chamber intraocular lens. In this study, we evaluated the ability to maintain an intact posterior capsule with the insertion of a posterior chamber intraocular lens during surgery. Of 898 eyes operated on, 15 (1.7%) developed rents in the posterior capsule, and seven of these had vitreous in the anterior chamber. Nine of the 15 rents were in eyes with either traumatic or hypermature lenses. We conclude that even in a developing nation where many cataracts are mature, hypermature, or traumatic, extracapsular cataract surgery with the insertion of a posterior chamber intraocular lens is technically feasible if surgeons are skilled and experienced.