During phacoemulsification cataract surgery, the surgeon inadvertently ruptures the posterior capsule during nucleus removal. Vitreous presents at the wound. What is the most important immediate step?

• A Immediately convert to extracapsular cataract extraction (ECCE)
• B Perform anterior vitrectomy to remove vitreous from the anterior segment before proceeding ✓
• C Inject viscoelastic and attempt to place the IOL in the sulcus without vitrectomy
• D Close the wound and plan secondary IOL implantation after 6 weeks

Explanation

Posterior capsule rupture with vitreous presentation requires immediate anterior vitrectomy to prevent vitreous incarceration, vitreous wick syndrome, and subsequent complications such as macular edema, retinal detachment, and endophthalmitis. After a thorough vitrectomy, the surgeon may place a three-piece IOL in the ciliary sulcus or the bag remnant if sufficient support exists. Leaving vitreous in the anterior segment risks chronic CME and retinal traction.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.