A retrospective study of patients with retained nuclear fragments after cataract extraction

Abstract

ABSTRACT.Purpose: A registration and follow-up of patients who underwent pars plana vitrectomy after dislocated nuclear fragments to the vitreous following cataract extraction. Material and methods: A retrospective study of 125 patients referred to The National Hospital during the years 1991 to 1998. Phacoemulsification and extracapsular technique were used in 115 eyes and 10 eyes, respectively. A pars plana vitrectomy was performed within an average of 13 days (1-99 days) after cataract extraction. Average follow-up period was 9 months (0.5-35 months). Results:The visual acuity at follow-up was Ø 0.5 in 67 eyes (55.4%), ∞0.5-Ͼ0.1 in 32 eyes (26.4%), and AE0.1 in 22 eyes (18.2%). The total number of retinal detachments was 26 (21.5%). Conclusion: Retained nuclear fragments in the vitreous is a serious complication and most eyes achieve acceptable visual results.

Immediate pars plana vitrectomy for dislocated intravitreal lens fragments during cataract surgery

“…This percentage is apparently lower compared with other published series with 41-82% of cases achieving a final visual acuity of 6/12 or better, regardless of the time interval between cataract and vitreous surgery. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]24 This may be due to a large proportion (31%) of our cases having pre-existing ocular diseases before cataract surgery, with an overall median preoperative visual acuity of 6/90. In the series by Kageyama et al, 5 the median preoperative visual acuity was 6/15 with only 12% of cases had pre-existing ocular comorbidity.…”

“…This rate of retinal detachment is within the range reported in other studies in which vitrectomy was performed later for retained lens fragment, which ranged from 0 to 21.5%. [6][7][8][9][10][11][12][13][14][15][16][17]19,20,21,24,25 This suggests that early vitrectomy does not prevent the problem of development of retinal detachment. The reattachment rate for retinal detachment after vitrectomy for retained lens fragment is usually favourable, but visual outcomes are often poor due to other comorbidities particularly cystoid macular oedema.…”

“…[6][7][8] Pars plana vitrectomy has been used successfully to retrieve the retained lens fragments in order to minimise the risk of further complications. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Although the optimal timing of pars plana vitrectomy remains controversial, 7,[10][11][12][13][14] histological studies have shown that inflammatory reaction is more severe with longer duration of lens fragments remaining within the eye. 22,23 The performance of pars plana vitrectomy to retrieve the dislocated lens fragments at the time of cataract surgery may therefore be beneficial to minimise postoperative inflammation and its associated morbidity, as well as eliminate the need of two separate operations.…”

Immediate Pars Plana Vitrectomy Improves Outcome in Retained Intravitreal Lens Fragments after Phacoemulsification

“…In previous studies in which vitrectomy was performed later for retained lens fragments, the rates of retinal detachment were within the range of 0–21.5% [4,5,6,7,9,10,11,12,13,14,15,16,22,23,24,25]. In previous studies in which vitrectomy was performed early for retained lens fragments, the rates of retinal detachment were within the range of 10–18% [3, 20].…”

Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery

“…These include corneal oedema, intraocular inflammation, ocular hypertension, vitreous haemorrhage, cystoid macular oedema and retinal detachment 2,4−21 . Pars plana vitrectomy with or without phacofragmentation to remove those significant lens particles is now generally recognized as the standard form of treatment 2,4−21 . The aim of this study was to investigate the risk factors for dislocation, its complications and final outcome of this group of patients.…”