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𝐌𝐚𝐧𝐚𝐠𝐞𝐦𝐞𝐧𝐭 𝐨𝐟 𝐜𝐨𝐦𝐩𝐥𝐢𝐜𝐚𝐭𝐞𝐝 𝐜𝐚𝐭𝐚𝐫𝐚𝐜𝐭 𝐬𝐮𝐫𝐠𝐞𝐫𝐲 𝐰𝐢𝐭𝐡 𝐝𝐫𝐨𝐩𝐩𝐞𝐝 𝐧𝐮𝐜𝐥𝐞𝐮𝐬

𝐌𝐚𝐧𝐚𝐠𝐞𝐦𝐞𝐧𝐭 𝐨𝐟 𝐜𝐨𝐦𝐩𝐥𝐢𝐜𝐚𝐭𝐞𝐝 𝐜𝐚𝐭𝐚𝐫𝐚𝐜𝐭 𝐬𝐮𝐫𝐠𝐞𝐫𝐲 𝐰𝐢𝐭𝐡 𝐝𝐫𝐨𝐩𝐩𝐞𝐝 𝐧𝐮𝐜𝐥𝐞𝐮𝐬 Dropped nucleus is the most feared complication of modern cataract surgery. It can happen to any eye surgeon, at any time. The crucial question is: how will you handle it? Once a dropped nucleus occurs, the first rule is to accept it. Then, safely deal with the problem. These are my top 3 tips for safe management: 𝟏-𝐂𝐥𝐞𝐚𝐫 𝐚𝐥𝐥 𝐜𝐨𝐫𝐭𝐢𝐜𝐚𝐥 𝐦𝐚𝐭𝐭𝐞𝐫 𝐚𝐧𝐝 𝐯𝐢𝐭𝐫𝐞𝐨𝐮𝐬 𝐟𝐫𝐨𝐦 𝐀𝐂 (to avoid corneal oedema, AC inflammation & high IOP). 𝟐-𝐏𝐫𝐞𝐬𝐞𝐫𝐯𝐞 𝐭𝐡𝐞 𝐚𝐧𝐭𝐞𝐫𝐢𝐨𝐫 𝐜𝐚𝐩𝐬𝐮𝐥𝐞 to allow for secure secondary sulcus IOL implantation and to avoid more complex scleral fixation surgery. 𝟑-𝐍𝐞𝐯𝐞𝐫 𝐜𝐡𝐚𝐬𝐞 𝐚𝐧𝐲 𝐝𝐫𝐨𝐩𝐩𝐞𝐝 𝐧𝐮𝐜𝐥𝐞𝐮𝐬 𝐨𝐫 𝐟𝐫𝐚𝐠𝐦𝐞𝐧𝐭𝐬 (as this can cause further problems). Following these tips will make subsequent vitrectomy surgery more straightforward with better visual outcomes. It worth mentioning that the outcome in the subsequent vitrectomy surgery is: 𝐧𝐨𝐭 𝐫𝐞𝐥𝐚𝐭𝐞𝐝 𝐭𝐨 𝐭𝐡𝐞 𝐬𝐢𝐳𝐞 𝐨𝐟 𝐭𝐡𝐞 𝐝𝐫𝐨𝐩𝐩𝐞𝐝 𝐩𝐚𝐫𝐭 (fragment or whole lens). 𝐧𝐨𝐭 𝐫𝐞𝐥𝐚𝐭𝐞𝐝 𝐢𝐟 𝐲𝐨𝐮 𝐢𝐦𝐩𝐥𝐚𝐧𝐭𝐞𝐝 𝐚𝐧 𝐈𝐎𝐋 𝐨𝐫 𝐧𝐨𝐭 (better not in the primary surgery). Patients with dropped nucleus will need further vitrectomy surgery to remove the dropped fragment or nucleus. The 2 main considerations that determine the outcome after vitrectomy surgery are 𝐈𝐬 𝐭𝐡𝐞 𝐚𝐧𝐭𝐞𝐫𝐢𝐨𝐫 𝐜𝐚𝐩𝐬𝐮𝐥𝐞 𝐢𝐧𝐭𝐚𝐜𝐭 𝐨𝐫 𝐧𝐨𝐭? So try to preserve anterior capsule by all means, as if it is damaged, you may change a straightforward subsequent vitrectomy to more complex scleral fixation surgery (with its own technical issues). 𝐈𝐬 𝐭𝐡𝐞 𝐞𝐲𝐞 𝐪𝐮𝐢𝐞𝐭 𝐟𝐨𝐫 𝐬𝐮𝐛𝐬𝐞𝐪𝐮𝐞𝐧𝐭 𝐦𝐚𝐧𝐚𝐠𝐞𝐦𝐞𝐧𝐭 𝐨𝐫 𝐧𝐨𝐭? So better clear all the vitreous and cortical matter from the anterior chamber as much as possible. If there is any residual cortex or vitreous in the anterior chamber, this may cause other problems (as corneal oedema, high IOP, AC inflammation... etc) making subsequent management more challenging and guarded prognosis. For more videos, visit my channel:    / @abdallahellabban   Subscribe to my channel: https://www.youtube.com/@abdallahella... For further information, visit my website: www.ellabban.co.uk