When a posterior capsule split occurs during surgery for a posterior polar cataract, the priority is to preserve the anterior hyaloid face so that the intraocular lens can still be placed safely in the capsular bag. Avoid hydrodissection entirely, as fluid waves can propagate through the pre-existing weakness and disrupt the hyaloid. Instead, use gentle hydrodelineation to create a smaller, more manageable nucleus while maintaining the epinuclear shell as a scaffold over the defect. Perform phacoemulsification with ultra–low flow, low vacuum, and a stable, closed system to minimize anterior–posterior chamber fluctuations. Epinuclear and cortical removal should rely on tangential stripping rather than radial traction, keeping aspiration forces away from the central defect. As long as the anterior hyaloid remains intact and no vitreous prolapse is seen, the capsular bag can accept a standard posterior chamber IOL if the haptics are placed in a stable orientation. Place the lens slowly and centrally, maintaining chamber stability throughout insertion.
