Time for another CataractQuiz™ to test your skills, knowledge, and power of observation. In this video, our anonymous guest surgeon performs a routine cataract case but then at the end of nucleus removal two holes are noted in the posterior capsule. Where did these holes come from? When did this happen? And how do you finish the case without further complications like vitreous prolapse? Comment below and please give your input – we are all here to learn together.
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During emulsification of the last piece, an occlusion break occurs at 2:18.12. A subtle surge here must have allowed the PC to bounce anteriorly and contact the tip, forming the smaller hole. After the last fragment flits about in the AC for a few fractions of a second, occlusion is re-established at 2:18.52. It breaks again at 2:19.49 as the last remnant capable of occluding the tip disappears. This allows the PC to bounce forward again, forming the larger hole. Keeping the 2nd instrument deeper and more central in the bag should reduce the risk of this happening in the future. Alternatively – and counterintuitively – removing the 2nd instrument from the eye before emulsifying the last piece will tend to stabilize the chamber and keep the PC back. This is thanks to elimination of fluid egress around the chopper and out the para.
Kudos to the surgeon for handling this with equanimity and safely getting the IOL in the bag without vitreous prolapse.