During phacoemulsification, the surgeon notes that the posterior capsule has ruptured and vitreous is prolapsing. The most critical immediate step to prevent vitreous incarceration in the wound and subsequent complications is:

• A Immediately inject viscoelastic to tamponade the vitreous and remove nuclear fragments as quickly as possible
• B Complete phacoemulsification without interruption since stopping risks further vitreous prolapse
• C Convert immediately to intracapsular cataract extraction
• D Recognise the complication, reduce irrigation flow to minimise vitreous prolapse, remove the phaco probe, and perform anterior vitrectomy to clear vitreous from the anterior segment before proceeding ✓

Explanation

Posterior capsular rupture with vitreous prolapse is one of the most serious intraoperative complications of phacoemulsification. The key priority is: (1) recognise early — stop I/A or phaco, reduce infusion pressure; (2) avoid further vitreous prolapse by reducing infusion and removing instruments carefully; (3) perform anterior vitrectomy (dry vitrectomy preferred initially) to cut and remove prolapsed vitreous, preventing vitreous incarceration in the wound which causes CME, IOL tilt, and retinal detachment. Injecting viscoelastic without clearing vitreous first may push vitreous further into the wound.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.