CataractCoach™ 2242: Cataract Quiz: What about this nuclear chip?

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This patient had a seemingly routine cataract surgery but after the IOL is placed into the intact capsular bag, a nuclear chip is noted behind the optic. But this cataract fragment is also behind the posterior capsule. We have explained previously that a fragment can slip through lax zonular support and end up behind the capsule in Berger's space. In quite a number of seemingly routine cataract cases we can see small opacities of lens material that have migrated in front of the anterior hyaloid face. In this case, what would be your approach? Please comment below.

Пікірлер: 33

@NIKETUS

For sure... leave it alone , inform the patients and relatives about it .. and then if needed, refer to a vitreous surgeon and live a longer stress free life

@bibabubu123

Personnaly I leave it alone and if required (post-op inflammation, blurring vision, ..;) I go back later.

@Tumalieh

Leave it in peace

@drdaviddelahunty4424

I'm with the leave-it-alone camp. It's tiny, in terms of inflammation generation, as it breaks down (different story in the anterior chamber). The risk of 2 port PPV has to be counted against the risk of postop inflammation, and I suggest there's no advantage in the second procedure.

@rekhangp1

I would leave as I am not comfortable putting trocars in the first sitting in a nice Phaco case

@zahedshehab8709

Sometimes you are economically limited to not doing anything .

@mustafizrahman.

I would leave it alone however I am interested to know what you do Uday?

@vsharmaophth

I would have left it alone …

@YYCEyeGuyGord

All are valid options. Leaving it could certainly be an option; but if the patient didn't want to have it blocking his/her vision for a time, a PCCC could certainly work as well. One of the cases where there's really no wrong answer, I feel. I probably would've done the PCCC and gotten it out that way, and it may have needed to be done anyway.

@EyeGPT

That piece deep dive to Vitreous cavity. Post surgery YAG capsulotomy will work instead of vitrectomy.

@eyekakadia

Uday, I would have left it alone…

@mujeebiqbal9984

This I would remove after posterior capsulotomy/ capsulorhexis.

@bouletteboulette7815

Primum non nocere, I would leave it there

@chuwitt

What should i do? if i cannot PPV

@Dr.AdnanAlHassani

Leave it, then wait and see. Anterior vit. floaters usualy do not bother. If it remained and blocked visual pathway, I will refer to VR colleague.

@dronasinha6610

Some times loose cortex ,,epinucleus bit or speck of nucleus observed in cases of lax zonules where in the above said track into anterior vitrous or bergers space .