Management of vitreous loss and dropped nucleus during cataract surgery

The intraoperative management of complication during cataract surgery of vitreous loss and dropped nucleus strongly influences the outcome, and a well-rehearsed plan for both staff and surgeons is needed. Preventative measures, early recognition, damage control, and resolution are discussed in this article. Maintenance of appropriate pressure relationships and tissue planes limits vitreous prolapse and the surgeon's primary goal is to avoid vitreous traction resulting in retinal tears and detachment. A pars plana approach to anterior vitrectomy with staining of the prolapsed vitreous is the most effective technique. Although residual lens material should be removed from the anterior and posterior chambers, once a fragment is lost to the posterior segment, the authors advocate referral for a standard three-port posterior vitrectomy with fragmenter as needed because the goal of the cataract surgeon is to offer the patient a clean, pseudophakic anterior segment and the best chance for an optimal visual recovery.