During phacoemulsification, a posterior capsule rupture occurs before nucleus emulsification is complete. The vitreous remains intact. Which is the most appropriate immediate next step?

• A Reduce bottle height, aspirate remaining cortex with bimanual IA, and consider anterior vitrectomy if vitreous presents ✓
• B Immediate conversion to ECCE (extracapsular cataract extraction)
• C Inject viscoelastic into anterior chamber and convert to manual small incision cataract surgery
• D Abandon the procedure and refer for vitreoretinal surgery

Explanation

Upon recognizing posterior capsule rupture without vitreous prolapse, the surgeon should immediately reduce infusion bottle height (to decrease IOP and vitreous pressure), convert to lower-flow aspiration, and carefully aspirate remaining nuclear and cortical material. If vitreous presents, anterior vitrectomy is performed before proceeding. A sulcus-placed IOL can then be implanted. Injecting viscoelastic anteriorly without controlling vitreous and converting to ECCE increases the risk of vitreous loss and nuclear drop.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.