During phacoemulsification, posterior capsule rupture (PCR) occurs. The surgeon notes vitreous presentation. The most critical next step to prevent nucleus drop and manage the complication is:

• A Immediately inject cohesive viscoelastic and continue phacoemulsification
• B Stop phacoemulsification, lower infusion bottle height, perform anterior vitrectomy to clear vitreous from anterior segment, and consider converting to ECCE or sulcus IOL placement ✓
• C Inject intracameral adrenaline to constrict the pupil and prevent vitreous prolapse
• D Immediately place the IOL in the capsular bag to prevent further vitreous prolapse

Explanation

Upon recognition of PCR with vitreous presentation during phacoemulsification, immediate steps are: stop phacoemulsification (to avoid pulling vitreous into wound), reduce infusion bottle height (to reduce posterior pressure), inject dispersive viscoelastic to tamponade vitreous, perform thorough anterior vitrectomy to clear all vitreous from the anterior segment and wound, and then decide IOL placement (sulcus if anterior capsule rim is intact, anterior chamber IOL if insufficient support). Allowing vitreous in the anterior segment leads to vitreous traction, cystoid macular edema, and retinal detachment.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.