1586: bringing the dropped nucleus up

If the posterior capsule ruptures and the nucleus drops during cataract surgery, my advice to you is to let it go. Let it descend into the vitreous cavity then clean up the anterior segment and close the eye. Refer the patient to your vitreo-retinal surgery colleagues and let them help you. Once the nucleus goes into the vitreous cavity, it becomes engulfed in vitreous and doing a full pars plana vitrectomy may be the best approach. In this video our guest surgeon was sent a patient with a dropped nucleus. After doing a thorough pars plana vitrectomy, he uses PFCL (perfluorocarbon liquid) to fill the vitreous cavity and float the nucleus up to the pupil. At this point it can be removed using the phaco probe and it tends to stay put since the PFCL is immiscible with the water in the BSS infusion. There are some pearls for this maneuver since the cataract can still move around.

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