During phacoemulsification, posterior capsule rupture (PCR) with vitreous loss occurs. The surgeon converts to manual small incision cataract surgery (MSICS) and completes cortical clean-up. Which IOL should be implanted?

• A Single-piece acrylic IOL in the capsular bag
• B Three-piece foldable IOL in the sulcus with optic capture through the capsulorhexis ✓
• C Anterior chamber IOL of angle-supported design
• D Iris-claw lens sutured to iris

Explanation

With PCR and adequate anterior capsular rim remaining, a three-piece IOL (with PMMA/poly-PVDF haptics) should be placed in the ciliary sulcus. Optic capture — pushing the optic posteriorly through the capsulorhexis edge while haptics rest in the sulcus — provides stable posterior IOL fixation and reduces UGH (uveitis-glaucoma-hyphema) syndrome risk compared to bare sulcus placement. Single-piece AcrySof IOLs have large angulated haptics designed for capsular bag placement; sulcus placement of single-piece IOLs causes chronic chafing of the uvea leading to UGH syndrome. Three-piece IOLs have thinner, smoother haptics compatible with sulcus placement.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.