During phacoemulsification, a posterior capsule rupture occurs with nuclear fragments in the anterior vitreous. The surgeon stabilizes the anterior chamber. The BEST next step is:

• A Attempt to aspirate the nuclear fragment through the same phaco wound with anterior vitrectomy
• B Terminate the case, close the wound, and refer for pars plana vitrectomy within 1–2 weeks ✓
• C Extend the wound, perform anterior vitrectomy, and extract remaining nuclear fragment manually via ECCE
• D Inject intravitreal triamcinolone to reduce vitreous inflammation and observe

Explanation

When nuclear fragments drop into the vitreous during phacoemulsification, the safest management is to stop attempting anterior retrieval, perform thorough anterior vitrectomy to cut all vitreous strands at the wound, implant an IOL in the sulcus (if anterior capsule support is adequate), close the wound, and refer for elective pars plana vitrectomy (PPV) within 1–2 weeks for retrieval of the dropped nucleus. Attempting to aspirate hard nuclear material from the vitreous anteriorly risks retinal damage, hemorrhage, and worse visual outcomes. The timing of PPV (within days to 2 weeks) prevents complications of retained lens material (uveitis, glaucoma, CME).

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.