Review: Complete this case without vitreous prolapse

This is a great learning case from one of our young surgeons in training. The video is 14 minutes long and that is after extensive editing. The entire surgery was actually about 45 minutes. The reason you must watch it is to learn the techniques that made it possible for this patient to have excellent vision the next day. Despite a wide-open posterior capsule and half of the nucleus still remaining, all cataract material was removed, the sulcus IOL was securely placed, and there was zero vitreous prolapse. This you must learn.

The video shows the moment when trouble started: the beginning resident inadvertently withdrew the phaco probe from the eye while it was in position 3. This caused a break in the anterior capsule in the sub-incisional area. But it was not realized until the first half of the nucleus was removed.

Care was taken to maintain the fluidics and keep the anterior chamber pressurized at all times. Fortunately, the anterior hyaloid face was intact and there was no vitreous prolapse. The sulcus IOL was carefully placed and the main incision sutured. At the end of the case, triamcinolone was placed to confirm the absence of vitreous. The case turned out great and the patient achieved excellent vision.

In rare cases, even expert surgeons will encounter an open posterior capsule during cataract surgery. Knowing how to properly manage it is critical to achieving the best results for the patient.

Click below to learn from this very important cataract surgery case:


  1. Which cartridge is used to inject a three piece IOL into the sulcus? The Alcon B or C cartridge to my knowledge does not fit through a 2.7 mm corneal incision. I generally have to enlarge the incision to 3.2 mm. Please set me straight on this. How large does the incision have to be to use an MA60AC lens? Which cartridge should I use to load this lens? thank you so much. I have a case tomorrow morning with a PC tear from an intravitreal injection.

      1. Uday: Thanks so much for getting back to me promptly on a Sunday. Your advice is invaluable as always!!

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