When a posterior capsule rupture (PCR) occurs, the surgeon’s immediate priority is stability. First, do not abruptly remove the phaco probe; maintaining infusion prevents anterior chamber collapse, which could cause vitreous prolapse. Switch the machine to a “Cortex” or “Visco” setting and inject a dispersive viscoelastic through a side port to support the lens fragments and tamponade the vitreous face. Once the eye is pressurized, the probe can be safely withdrawn. If vitreous has entered the anterior chamber, a bimanual anterior vitrectomy is necessary to clear the incision sites and pupillary plane. Avoid “fishing” for fragments. Once the vitreous is managed, the remaining cortex should be removed using dry aspiration. Depending on the remaining capsular support, the surgeon can then determine if an IOL can be placed in the sulcus or if an alternative fixation method is required.
