Peeling a posterior capsule plaque is a high-stakes maneuver that requires a delicate touch and steady nerves. These plaques are often fibrotic opacifications of the central posterior capsule that can significantly limit postoperative visual acuity if left behind. The primary surgical challenge lies in the anatomy: the posterior capsule is incredibly thin, typically just 4 microns centrally, leaving little margin for error. The technique involves using fine intraocular forceps to gently grasp the edge of the plaque and peel it away from the underlying capsule. Success depends on maintaining a stable anterior chamber with viscodissection to create a slight separation between the plaque and the fragile membrane. If the plaque is too adherent, the surgeon must decide whether to continue the peel or pivot to a primary posterior capsulorhexis. Mastering this skill allows for a pristine visual axis without the need for an early YAG laser capsulotomy.
