This case poses a big challenge: the posterior capsule ruptures and we realize this when there is suddenly a pronounced gap between the iris and the anterior lens capsule. The nucleus now begins to fall into the vitreous cavity. This is no time to continue attempts at phacoemulsification. We need to convert from phaco to a manual extra-capsular cataract extraction (ECCE) technique. This video takes you through this process, step by step. There is virtually a 100% chance that you will need to perform this technique, while under pressure and stress, in your own operating room in the future. The time to learn it is now!
click to learn how to convert from phaco to manual ECCE surgery:
Thank you for sharing. I have one question: in a case like this one, what anesthesia was patient originally given? Was it intracameral? Once decision was made to convert to ECCE was further anesthesia administered, and if so, what? Thank you.
Great point. Thanks for bringing that up. This patient had a retrobulbar block done prior to starting the cataract surgery. If the procedure started off with topical anesthesia then yes, a sub-tenons block would be indicated prior to incising the conjunctiva.