During phacoemulsification, the surgeon notices posterior capsule rupture with vitreous loss. The nuclear fragment drops into the vitreous cavity. What is the correct immediate intraoperative management priority?

• A Stop phacoemulsification, perform anterior vitrectomy to clear prolapsed vitreous, and refer for pars plana vitrectomy ✓
• B Immediately attempt to retrieve the nuclear fragment with a phaco probe
• C Convert to ECCE and attempt extraction through a large wound
• D Inject intracameral triamcinolone and close the wound

Explanation

On posterior capsule rupture with vitreous loss, the immediate priority is to stop all phacoemulsification to avoid further vitreous traction and nucleus drop. Anterior vitrectomy removes prolapsed vitreous from the anterior segment, preventing pupillary block, ghost cell glaucoma, and cystoid macular oedema. The dropped nuclear fragment must be removed later by pars plana vitrectomy by a vitreoretinal surgeon — attempting immediate retrieval with the phaco probe causes further vitreous traction and retinal damage. ECCE conversion does not address vitreous management. Triamcinolone injection alone does not address the mechanical emergency.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.