In intumescent white or Morgagnian cataracts, the liquefied lens cortex, often referred to as milky lens fluid, can sometimes migrate into the vitreous cavity even without a frank rupture of the posterior capsule. This may occur through micro-defects or increased permeability of a thinned and fragile posterior capsule, particularly in long-standing hypermature cataracts. During hydrodissection or capsulorhexis, sudden decompression of the capsular bag can create a pressure gradient that forces the milky fluid posteriorly. Although the posterior capsule may appear intact, this fluid can still track into the anterior vitreous and provoke an inflammatory response. This is a rare occurrence and I have not encountered in during my 30 years in ophthalmology. If you have ever seen this, please comment below so that we can learn together. What is the best next step?
