During phacoemulsification, posterior capsule rupture occurs. The surgeon notices vitreous prolapse into the anterior chamber. Which is the CORRECT sequence of management steps?
- A Immediately inject viscoelastic, remove lens material with phaco probe, then perform anterior vitrectomy
- B Stop irrigation immediately, remove phaco tip, inject intracameral triamcinolone to stain vitreous, perform careful anterior vitrectomy with low-flow cutting ✓
- C Enlarge the incision to 5 mm and convert to ECCE for safe lens removal
- D Inject air bubble to tamponade vitreous, complete phacoemulsification of remaining nuclear fragments
Explanation
On posterior capsule rupture with vitreous prolapse: immediately stop phaco irrigation to prevent further vitreous prolapse; withdraw the phaco probe; triamcinolone acetonide (Kenalog) can be injected to stain vitreous (it is not naturally visible). A careful anterior vitrectomy with cutting mode, low aspiration/flow, and a separate vitrector is then performed to clear the anterior chamber of vitreous. Attempting to continue phacoemulsification risks extension of the tear and dropping nucleus into vitreous. Air does not tamponade vitreous; ECCE conversion is not a standard initial step.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.