Posterior capsule rupture during phacoemulsification is a recognized intraoperative complication. If posterior capsule rupture occurs with vitreous prolapse into the anterior chamber, the MOST appropriate immediate next step is:

• A Continue phacoemulsification aggressively to complete nucleus removal quickly
• B Perform anterior vitrectomy to clear the vitreous from the anterior segment before attempting any IOL implantation ✓
• C Inject viscoelastic and attempt to reposition the nuclear fragment posteriorly
• D Immediately close the eye and schedule posterior vitrectomy the next day

Explanation

When posterior capsule rupture occurs with vitreous prolapse, the top priority is removal of vitreous from the anterior chamber using an automated anterior vitrectomy (cutting-aspiration). Allowing vitreous to remain in the anterior segment causes vitreous traction, cystoid macular edema, chronic uveitis, and risk of retinal detachment. Continuing phacoemulsification with vitreous present is dangerous and risks extending the rupture. After thorough anterior vitrectomy and depending on the extent of remaining capsular support, the IOL can be implanted in the bag if sufficient capsular rim exists, in the sulcus, or scleral fixation may be required.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.