If the posterior capsule breaks during cataract surgery and vitreous presents to the anterior chamber, patients are best served by anterior vitrectomy using a pars plana technique, said Louis "Skip" Nichamin, MD, medical director, Laurel Eye Clinic, Brookville, PA.

"When handled properly, I believe the potential outcome after posterior capsule rupture can rival that of an uncomplicated case both anatomically and visually, but only if surgeons adhere to several fundamental surgical principles," Dr. Nichamin said. "These principles are best achieved using a pars plana approach to vitrectomy."

One of the advantages of the pars plana vitrectomy approach is that it enables a truly closed chamber environment, which also reduces intraocular turbulence, because the phaco incision is hydrated, sutured, and sealed. Importantly, the pars plana approach also allows a more limited yet more thorough clean-up of vitreous in a safer fashion relative to performing vitrectomy through the limbus.

"Because the vitreous is being pulled down, the pars plana technique allows definition of a better endpoint and can potentially decrease vitreoretinal tractional forces," Dr. Nichamin said.

As another benefit, the pars plana approach affords better access to remaining lens material, especially within the subincisonal area that can be difficult to reach from the limbus. In addition, the pars plana technique is more likely to preserve capsular support for IOL placement.

"I certainly don't mean to sound cavalier about this technique," Dr. Nichamin said. "It is incredibly important to practice it first through course study, wet lab instruction, and by observing others."