Dr. Christenbury removes a dense posterior capsular plaque with retinal microforceps while preserving the posterior capsule after extracting an intumescent white cataract.
![](https://crstodayeurope.com/wp-content/uploads/sites/5/2022/01/Christenbury_Step1.jpg)
1. The patient presents for cataract surgery 3 months after undergoing ruptured globe repair elsewhere. The capsule is stained with trypan blue dye, and a 27-gauge needle is used to decompress the intumescent white cataract.
![](https://crstodayeurope.com/wp-content/uploads/sites/5/2022/01/Christenbury_Step2.jpg)
2. As the capsulorhexis is created, a second pair of forceps is used to grasp the sclera to provide countertraction and better grasp the anterior capsule.
![](https://crstodayeurope.com/wp-content/uploads/sites/5/2022/01/Christenbury_Step3.jpg)
3. The capsulorhexis runs out beneath the incisions. A cystotome is used to make another nick in the anterior capsule, and the capsulorhexis is completed from the other side. The anterior capsulorhexis is still intact.
![](https://crstodayeurope.com/wp-content/uploads/sites/5/2022/01/Christenbury_Step4.jpg)
4. An opacity in the nasal-posterior area of the lens raises suspicion that the posterior capsule has been violated. Viscodissection is performed, and the nucleus comes out easily with little phaco energy.
![](https://crstodayeurope.com/wp-content/uploads/sites/5/2022/01/Christenbury_Step5.jpg)
5. A dense posterior plaque is adherent to the intact posterior capsule. An OVD is injected behind the plaque, dissecting it from the posterior capsule.
![](https://crstodayeurope.com/wp-content/uploads/sites/5/2022/01/Christenbury_Step6.jpg)
6. Intraocular scissors are used to detach the plaque from the equator and the anterior portion of the lens capsule.
![](https://crstodayeurope.com/wp-content/uploads/sites/5/2022/01/Christenbury_Step7.jpg)
7. The dense plaque is peeled from the posterior capsule with 25-gauge forceps. The maneuver is performed slowly and gently to remove all of the plaque.
![](https://crstodayeurope.com/wp-content/uploads/sites/5/2022/01/Christenbury_Step8.jpg)
8. A three-piece IOL is implanted and rotated into the capsular bag. The lens centers nicely. The OVD is removed from the eye, and the main incision is closed with 10-0 nylon sutures to ensure proper wound closure.