The surgery seems perfect, the IOL is centered, and the cortex is clear but as you hydrate the incisions, you notice a few small lens particles floating behind the posterior capsule. These tiny lens fragments are trapped in Berger’s space, the interface between the posterior capsule and the anterior hyaloid face. And they got there due to some degree of zonular laxity. This usually happens in cases of mild to moderate zonulopathy where the pressure differential pushes small nuclear chips around the equator, through the loose zonular support, and into Berger’s space in front of the anterior hyaloid face. At this stage, resist the urge to be a hero. If the posterior capsule is intact and the particles are small and cortical, leave them alone. Attempting to aspirate them requires breaking the anterior hyaloid, which converts a clean case into a complex vitrectomy. If the IOL is stable, the risk of chasing these tiny specks far outweighs the benefit. Follow the patient closely and these usually resorb without incident. Have you seen this before? Comment your experience below.
