1162: resident posterior capsule rupture

This resident experiences a posterior capsule rupture during phaco and there is still a lot of nuclear lens material in the eye. How can the case be completed without losing nuclear pieces into the vitreous? There are a few options. The traditional method would be to bring the nuclear pieces into the anterior chamber, make a larger scleral incision, and then manually express these pieces. That certainly works but there are other choices. The nuclear material can be brought up into the anterior chamber and then a scaffold can be used — this can be a Sheets glide but it can also be a three piece IOL. This scaffold keeps the nuclear pieces up in the anterior chamber while keeping most of the vitreous back. You can also use dispersive viscoelastic as a barrier to keep the nuclear pieces up and limit vitreous prolapse. This is what was done in this case and it is a very reasonable approach. What would you have done?

click to learn from this resident case of a ruptured posterior capsule: