During phacoemulsification of a dense brunescent cataract, the posterior capsule ruptures during nucleus management. The surgeon completes cortex aspiration, performs an anterior vitrectomy to manage vitreous loss, and plans IOL implantation. In the presence of a posterior capsule tear with anterior vitreous in the anterior chamber, the SAFEST IOL option is:

• A Implant a standard posterior chamber IOL in the capsular bag
• B Abandon IOL implantation and leave aphakic permanently
• C Implant the IOL in the sulcus over an intact anterior capsular rim without vitrectomy
• D Implant an anterior chamber (AC) IOL or sutured scleral-fixated PC IOL, depending on zonular status and extent of capsule loss ✓

Explanation

When posterior capsule rupture results in insufficient capsular support for in-the-bag IOL implantation, the surgeon has several options: (1) sulcus placement of a 3-piece PMMA or acrylic IOL over an intact anterior capsular rim (if adequate support remains after vitrectomy), (2) anterior chamber IOL (ACIOL) — angle-supported or iris-claw Artisan, or (3) scleral-fixated posterior chamber IOL (sutured or sutureless flanged Yamane technique). The choice depends on capsular remnants, zonular integrity, anterior chamber depth, and corneal health. Implanting into a bag with a significant tear risks dislocation; permanent aphakia is not acceptable when correction options exist.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.