A highly experienced surgeon is more likely to experience a rupture of the posterior capsule during cortex removal rather than with nucleus phacoemulsification. When a posterior capsule rupture occurs during capsular bag cleaning, the priority is to maintain anterior chamber stability and prevent vitreous prolapse. Immediately stop irrigation/aspiration, inject a dispersive ophthalmic viscosurgical device (OVD) to tamponade the rent, and withdraw instruments carefully. Avoid chamber collapse at all costs. Stain with triamcinolone if vitreous loss is suspected, and if there is prolapse vitreous then perform a meticulous anterior vitrectomy. In this case I was able to keep the anterior hyaloid face intact and avoid vitreous prolapse. Now the question is where / how to implant the toric IOL that is needed to treat the patient’s corneal astigmatism? What would you do? Comment below
