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.
