During phacoemulsification surgery, the surgeon notices the posterior capsule rupture with vitreous prolapse. Nucleus fragments have already been removed. The anterior chamber maintainer is in place. What is the MOST appropriate immediate next step?
- A Immediately convert to extracapsular extraction (ECCE) to remove residual cortex
- B Inject triamcinolone to stain vitreous, perform anterior vitrectomy, and convert to anterior segment IOL placement ✓
- C Enlarge the wound and manually extract all remaining cortex under viscoelastic
- D Abort the surgery and reschedule for pars plana vitrectomy after 6 weeks
Correct answer: B. Inject triamcinolone to stain vitreous, perform anterior vitrectomy, and convert to anterior segment IOL placement
Explanation
When PCR with vitreous prolapse occurs with no residual nuclear fragments, the correct management is to stain vitreous with triamcinolone acetonide (to visualize vitreous strands), perform thorough anterior vitrectomy to clear vitreous from the anterior segment, and then place a sulcus-fixated IOL or anterior chamber IOL depending on capsular support. Enlarging the wound risks more vitreous traction; immediate ECCE without vitrectomy risks vitreous incarceration. Aborting surgery entirely is appropriate only if there is dropped nucleus requiring PPV.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.