A posterior capsule rupture occurs during phacoemulsification. The nucleus has been removed but cortical material remains. The vitreous face is intact. What is the MOST APPROPRIATE immediate step?
- A Proceed with cortical aspiration using the I/A probe at high vacuum
- B Convert to ECCE and proceed
- C Lower infusion pressure, switch to low-flow parameters, carefully complete cortex removal with bimanual I/A, then consider sulcus IOL ✓
- D Inject dispersive viscoelastic into the anterior chamber and leave the residual cortex
Correct answer: C. Lower infusion pressure, switch to low-flow parameters, carefully complete cortex removal with bimanual I/A, then consider sulcus IOL
Explanation
When posterior capsule rupture is recognised with an intact vitreous face, the priority is to prevent vitreous prolapse. This requires lowering infusion bottle height/pressure, avoiding high vacuum, and carefully completing cortical removal with bimanual irrigation/aspiration at low flow. A sulcus-fixated IOL can be placed if sufficient capsular/sulcus support exists. High vacuum I/A will aspirate vitreous and worsen the situation. Conversion to ECCE is not necessary if vitreous is not presenting. Abandoning residual cortex risks inflammatory complications.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.