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Aim-To evaluate outcome of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens material. Methods-Clinical records associated with consecutive 8536 phacoemulsification procedures were reviewed retrospectively. Results-17 (0.20%) eyes had a posterior capsule rupture with retained lens material in the vitreous cavity that required vitrectomy. Final visual acuity was 0.5 or better in 14 eyes (82%) and 0.4 to 0.1 in three eyes (18%). Retinal detachment occurred in one eye during vitrectomy and two after the surgery. Cystoid macular oedema was observed in two eyes and none developed glaucoma. The corneal endothelial cell loss was 5.7% (SD 6.8 %) (n=15) at 3-6 months postoperatively. Conclusions-Combined vitrectomy and intraocular lens implantation at the time of phacoemulsification complicated by intravitreal lens material is an option to be considered to reduce the risk of postoperative complications including secondary glaucoma and corneal endothelial cell damage. (Br J Ophthalmol 2001;85:1038-1040 Dislocation of crystalline lens fragments into the vitreous cavity is an uncommon but potentially serious complication of cataract surgery. It can lead to marked intraocular inflammation resulting in cystoid macular oedema, vitreous opacification, glaucoma, and retinal detachment. [1][2][3][4][5][6] For the purpose of reducing the further ocular damage, since 1992 we have routinely converted to three port vitrectomy in such case.The first purpose of present study was to estimate the incidence of complicated phacoemulsification and aspiration (PEA) which needed vitrectomy to remove lens fragments in the vitreous; secondly, to evaluate intraoperative and postoperative complications and visual outcome after the procedure. Patients and methodsWe retrospectively reviewed the operative records of consecutive patients who underwent PEA from 1 June 1992 to 31 December 1999 at University of Showa, Fujigaoka Hospital, using computerised electronic databases. A total of 8536 PEA procedures were performed during the study period and 17 (0.20%) were combined with vitrectomy for removal of lens material. All eyes had a large fragment of lens material in the vitreous cavity at least one third the size of the nucleus. A total of 7295 surgeries were performed by 11 senior surgeons who were very experienced in vitrectomy. Others were by 21 ophthalmological trainees. Surgical procedures of vitrectomy included three port pars plana vitrectomy, three port pars plana vitrectomy with phacofragmentation, or three port limbal based vitrectomy. In the case of trainee operators, vitrectomy was performed by the senior surgeon who was to be available any time in the operating theatre.The imaging of the corneal endothelium was used for detailed evaluation of surgical intervention. The images were recorded with a specular microscope (SP-8000, Konan Co, Hyogo, Japan), and the density of endothelial cells was analysed both before and 3-6 months after the operation. We compared the results of the study group wi...

A 67-year-old woman had droplets of silicone oil adhering to her silicone intraocular lens (IOL) resulting from a previous silicone oil tamponade. A lens hook and intraocular irrigation were used in conjunction by inserting an infusion cannula to remove the droplets. This restored clarity of the visual axis, improved visual acuity, and eliminated the need for IOL replacement. The technique is simple and less invasive than IOL exchange and may become the preferred way to remove silicone droplets from an IOL.

Aims: To assess the results of temporal incision phacoemulsification and aspiration performed with dominant and non-dominant hand of ophthalmology trainees. Methods: Retrospective analysis were made of 203 surgeries with dominant hand and 207 with non-dominant by five trainees at two institutions. Trainees sat at the patient's head, manipulating instruments with the dominant right hand for the right eye, and the non-dominant left hand for the left eye. Results: Vitreous loss occurred in 12 (5.9%) of 203 dominant operated eyes and seven (3.4%) of 207 non-dominant operated eyes. The rate of endothelial cell loss was 6.1% (9.8%) in dominant and 7.4% (12.4%) in non-dominant. Mean ultrasound time were 1.81 (0.70) minutes in dominant and 1.78 (0.78) minutes in non-dominant. One trainee showed statistically significant excesses in incidence of vitreous loss in dominant operated eyes (8.7%, p=0.0270), and one showed statistically significant prolongation of the operation in nondominant operated eyes (26.3 minutes, p=0.0315). In all other trainees, all parameters had no difference in both sides. Conclusions: Ophthalmology trainees could successfully learn the technique with both hands. The authors consider that the skill of the non-dominant hand may be knowledge based and that surgeons avoid mistakes by mental efforts.T he temporal incision procedure of phacoemulsification and aspiration (PEA) is used by more than half of the cataract surgeons according to the latest ASCRS survey in 2000.1 Surgeons are usually seated at the patient's side for the procedure; however, this requires repositioning of the surgeon's chair and surgical equipment if the next surgery is on the opposite side. Such a task greatly increases staff requirements in the operating room, risk of infection, and miscellaneous incidents. To avoid such repositioning, we developed a technique for performing phacoemulsification while seated at the patient's head. The incision is made and the phaco tip is manipulated with the surgeon's right hand for the right eye, and the left hand for the left. Concern arose about difficulty in learning this procedure because it demands skill of the non-dominant hand. We made a retrospective analysis of the results of our technique performed with dominant versus non-dominant hand, considering outcomes of PEA by ophthalmology trainees at two institutions.

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