This patient had uneventful cataract surgery in the first eye with placement of a toric trifocal IOL in the capsular bag and a beautiful visual result. For the second eye, the case was also routine and without issue until the capsular bag was cleaned using the I/A probe. At that time, in a fraction of a second, a hole developed in the posterior capsule. This was instantly recognized and I immediately reacted by releasing vacuum while maintaining infusion to keep the anterior segment pressurized. By doing this, the anterior hyaloid face remained intact and there was no vitreous prolapse. An attempt at a posterior capsulorhexis was made because that would have prevented further extension.
This patient needs this toric trifocal IOL in order to have balance between the eyes, so we have to be very careful to avoid vitreous prolapse and keep sufficient capsular support for in-the-bag IOL placement. Capsular bag was successfully inflated with viscoelastic and the IOL was implanted in the bag and oriented at the steep corneal meridian for treatment of the astigmatism. The case went very well and the patient achieve an excellent visual outcome that matched the first eye perfectly.
All surgeons will encounter cataract cases like this where a combination of many factors, including patient anatomy, will result in a ruptured posterior capsule. The key is to recognize it instantly and then react to prevent further issues. The result is a beautiful outcome.
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