Evaluation of the anterior hyaloid using intraoperative optical coherence tomography: a key strategy in complex cataract surgery.

Cataract surgery in patients with high myopia and a history of multiple intravitreal injections carries an increased risk of complications. We report the case of a 57-year-old highly myopic patient with a phakic intraocular lens and a history of multiple intravitreal injections who experienced posterior capsular rupture during surgery. The use of intraoperative anterior segment optical coherence tomography enabled confirmation of the integrity of the anterior hyaloid, which proved crucial for adapting surgical maneuvers and avoiding anterior vitrectomy. This case underscores the value of intraoperative optical coherence tomography as a real-time diagnostic tool for tailoring surgical strategy and minimizing risk in complex cases. Its use may be particularly beneficial in highly myopic patients with prior intravitreal treatments, in whom careful assessment of the vitreolenticular interface is essential to maintain posterior segment stability.