Our anonymous surgeon thinks that the case is going beautifully but then with IOL insertion, the entire IOL starts dropping into the vitreous cavity. Why? When did this happen? The complication of capsule rupture happened much earlier than this surgeon expected and it was seemingly subtle so it was not noticed. Watch the video carefully and can you determine when the capsule complication happened? Please comment your answer below.
It’s tempting to grab an IOL which has moved posteriorly through an open posterior capsule, but just because you technically can still grasp it doesn’t mean you necessarily should. In this case, at the point where the IOL is vertically oriented and mostly down in the anterior vitreous, I would have abandoned the IOL. There’s literally no way to pull it forward from there without pulling a bunch of vitreous forward along with it. Do the anterior vitrectomy, place a sulcus IOL if there is sufficient support, and then call your Retina colleague. Much safer to move this IOL forward (and out of the eye) with the support of a pars plana vitrectomy.