The only ophthalmologists who have zero surgical complications are those who don’t operate and those who are not fully truthful. The rate of complications from cataract surgery decreases as the surgeon skill improves. While a resident surgeon in training can have a 5% (or higher) rate of capsular rupture during cataract surgery, a true expert will have a rate that is much less than 1%. This rate can never be absolutely zero because even if there is no iatrogenic damage, the rare patient can have bad tissue.
This means that during the course of learning cataract surgery, beginning surgeons will certainly encounter a significant number of patients who need proper management of a ruptured posterior capsule, vitreous prolapse, and a dropped nucleus. This video shows two different approaches to performing the anterior vitrectomy: (1) with the vitrector inserted at the limbus and (2) with the vitrector inserted via the pars plana. Each approach is discussed and the technique is explained in detail.
Should you put an IOL in this eye after the vitreous has been cleared from the anterior segment? It depends on your vitreo-retinal colleague. If the retina surgeon wants to bring the nucleus up through the pupil and emulsify it in the anterior segment, then leave the patient aphakic. If the retina surgeon prefers to use the fragmatome to remove the nucleus while it is in the vitreous cavity, then you should securely place a three-piece IOL.
Click below to learn from this important case before you need to use these techniques: