This patient had a pars plana vitrectomy for retinal pathology and then developed this central posterior capsule opacity shortly thereafter. This round area is likely iatrogenic in nature from the vitrector and pre-op OCT imaging confirms that the posterior capsule appears to have sustained some damage. The question is how do you approach this case surgically to avoid a large posterior capsule rupture? With no vitreous remaining, a large break in the posterior capsule will allow the nucleus to rapidly fall into the vitreous cavity. My approach would be to treat this like a posterior polar cataract or use the techniques that Dr Tom Oetting described here. Our guest surgeon does a great job with this tough case and implants the IOL in the capsular bag.
The fact that the capsule is in fact intact – does this mean the PC was breached and healed over (can that happen?) or did it just go very close and cause some cataract?
likely just damaged the posterior capsule without perforating it. the capsule will not heal over if penetrated