Lens and cataract: dropped nucleus: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Lens and cataract: dropped nucleus

Sample item

During phacoemulsification the posterior capsule ruptures and hard nuclear fragments sink into the vitreous. After the anterior chamber is cleared of vitreous, what is the best approach to the lost fragments?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Do not chase them; refer for early pars plana vitrectomy and lens removal

Blind attempts to retrieve or emulsify nuclear fragments in the vitreous cause traction, retinal tears and detachment. The safe course is to perform an anterior vitrectomy, remove cortex, consider the lens placement, and refer for pars plana vitrectomy with fragmentation of the retained nucleus.

Option by option

  • A. Emulsify them in the vitreous with higher phaco power

    Phaco energy in the vitreous harms the retina and does not safely fragment the nucleus.

  • B. Do not chase them; refer for early pars plana vitrectomy and lens removal (correct)

    Correct. Retained heavy fragments are managed by a vitreoretinal surgeon with pars plana vitrectomy.

  • C. Fish for them blindly with forceps through the corneal wound

    Blind forceps retrieval tears the vitreous base and the retina.

  • D. Leave them in place with topical steroids alone

    Leaving hard fragments causes severe inflammation, glaucoma and corneal decompensation.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is B, Do not chase them; refer for early pars plana vitrectomy and lens removal. Blind attempts to retrieve or emulsify nuclear fragments in the vitreous cause traction, retinal tears and detachment.

Why is "Emulsify them in the vitreous with higher phaco power" not the answer?

Phaco energy in the vitreous harms the retina and does not safely fragment the nucleus.

Why is "Fish for them blindly with forceps through the corneal wound" not the answer?

Blind forceps retrieval tears the vitreous base and the retina.

Why is "Leave them in place with topical steroids alone" not the answer?

Leaving hard fragments causes severe inflammation, glaucoma and corneal decompensation.

What concept does this question test?

It tests Lens and cataract: dropped nucleus in Ophthalmology. The safe course is to perform an anterior vitrectomy, remove cortex, consider the lens placement, and refer for pars plana vitrectomy with fragmentation of the retained nucleus.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Lens and cataract: dropped nucleus?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.