In this cataract surgery, a posterior capsule tear is identified during nuclear disassembly. The resident makes many mistakes in management, and there is a lot to be learned from watching this video.
1. Once you identify a posterior capsular tear, viscoelastic should be placed in the eye PRIOR to removal of your phaco probe. If this isn’t done, removing the phaco probe decreases the pressure in the AC and causes anterior prolapse of the vitreous. This disrupts the anterior hyaloid face.
2. The posterior rupture continued to enlarge in this case due to anterior prolapse of the vitreous. This can be prevented by placing viscoelastic in the anterior chamber prior to removal of the phaco probe.
4. Triamcinolone should be used to stain the vitreous to identify any vitreous in the anterior chamber.
5. Cartridges for three piece lenses are larger than those for one piece lenses. If you initially planned on a one piece, you should enlarge the incision prior to any attempt at cartridge insertion.
6. Any sulcus lens should be inserted in the anti-S position.
7. Ensure there is adequate pressure in the AC prior to closing the incision with 10-0 nylon.