Prior pars plana vitrectomy (PPV) makes the cataract surgery more challenging because it removes the anterior hyaloid face and vitreous which normally provide support to the central nucleus during phaco. With the capsular bag and nucleus only supported by the zonular attachments, there can be a trampoline effect during phaco particularly when working within the bag. To avoid these issues, I like to partially prolapse and tilt one edge of the nucleus above the capsulorhexis. This allows me to work at the iris plane and avoid issues with trampolining of the capsular bag. The result is a safe and efficient surgery. I also adjust the IOL power calculations because the optic may sit somewhat closer to the retina. More details explained in the video.
