Every cataract surgeon will experience a ruptured posterior capsule and vitreous prolapse as a complication. The key is to recognize the issue, react appropriately, and then recover. The rate of capsule rupture and vitreous loss decreases with time, as the surgeon gets more experience. During training this can be a rate of up to 5 or 6% and then decreases to half that within a year or two of practice. Highly experienced cataract surgeons can lower this rate to 1 in 1,000 or even less.
This video is longer than most, clocking in at 12 minutes. We show the critical parts of the case, in high speed, and we even give you suggested machine settings for performing the anterior vitrectomy. I am happy to report that this patient is doing well and the resident is now knowledgeable in the skill of performing an anterior vitrectomy.
Click to learn from this must-see video because you will need these skills in the future:
If a radial tear is suspected, it is probably prudent to minimize manipulating the lens fragments excessively. Placing dispersive viscoelastic behind the lens fragments prior to phaco would provide extra margin of safety. The dispersive viscoelastic would displace the lens fragment anteriorly and pushes the posterior capsule back. Great video.
I remember you said the tear goes where the forceps go, very evident in this case