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

Lai, Timothy Y. Y.; Kwok, Anthony; Yeung, Y.-S.; Kwan, K. Y. W.; Woo, Donald C.F.; Yuen, Kam‐Tong; Loo, Angela

doi:10.1038/sj.eye.6701708

Cited by 28 publications

(19 citation statements)

References 26 publications

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“…However, the development of secondary glaucoma was observed in all patients in groups B and C. This is in agreement with the findings of Kageyama et al [3], Kim et al [6] and Lai et al [20], in that none of their patients who underwent vitrectomy for dislocated lens fragments on the same day as cataract surgery developed secondary glaucoma. This is an important finding because secondary glaucoma has been reported in 5–41% of subjects in previous studies in which pars plana vitrectomy was performed at a later time [4, 6,9,10,11,12,13,14,15].…”

Section: Discussionsupporting

confidence: 82%

“…In our study, none of the patients in group A or B developed cystoid macular edema, whereas 3 of 11 patients (27%) in group C did. This is similar to the findings of Kim et al [6] and Lai et al [20], in which no patient developed postoperative cystoid macular edema after undergoing vitrectomy on the same day as complicated cataract surgery. Margherio et al [10] found that 27% of their patients developed postoperative cystoid macular edema after vitrectomy as a late postoperative complication.…”

Section: Discussionsupporting

confidence: 81%

“…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]. A trend to an increased incidence of retinal detachment in eyes that underwent delayed vitreous surgery was observed by Margherio et al [10].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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Purpose: To investigate the clinical features, visual acuity outcomes and the most appropriate intervention time in patients with retained lens fragments managed by pars plana vitrectomy. Methods: This was a retrospective review of the records of 78 patients who underwent pars plana vitrectomy for retained lens fragments at the Tri-Service General Hospital from January 1, 2000, to December 31, 2006. Results: The mean age of the patients was 70 years (range, 24–92 years). There were 40 men (51%) and 38 women (49%). The mean follow-up period after surgery was 13.8 months. Forty-five patients (58%) had vitrectomy within 1 day of phacoemulsification (group A), 22 (28%) within 1 week (group B) and 11 (14%) after more than 1 week (group C). No patients in group A developed complications, and 76% achieved a final visual acuity of 6/12 or better. In group B, all patients had elevated intraocular pressure, and 45% achieved a final visual acuity of 6/12 or better. In group C, all patients presented with corneal edema, moderate or severe uveitis, and elevated intraocular pressure. Of these patients, 27% had cystoid macular edema, 36% developed retinal detachment, and 27% had a final visual acuity of 6/12 or better. Conclusion: Pars plana vitrectomy performed immediately after cataract surgery for retained lens fragments is a viable option and may achieve a better visual outcome, with reduced risk of secondary glaucoma, retinal detachment or cystoid macular edema.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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

et al. 2008

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“…Timing of Vitreoretinal Surgery: 13,14,15 Ideally in the same sitting. Early surgery is preferred if significant nuclear matter is retained, it reduces the incidence of post-operative glaucoma and is associated with better visual outcomes…”

Section: Intra-operative Managementmentioning

confidence: 99%

Analysis of Risk Factors, Visual Outcomes After Vitrectomy and Iol Implantation for Dropped Nucleus

Gosai¹,

Limbasiya²,

Gajendragadkar³

et al. 2015

jemds

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PURPOSE:To determine predisposing factors and to analyze visual outcomes after a dropped nucleus in vitreous originating during cataract surgery. Evaluation of management and outcome of patients undergoing pars plana vitrectomy. Evaluation of risk factors for poor visual outcomes, comparison of visual acuity following various types of IOL implantation. METHODS: 30 patients were prospectively reviewed having dropped nucleus or retained lens matter over a period of 11 months to determine the various associated factors and prognosis after pars plana vitrectomy and IOL implantation. Pre and Post-operative visual acuity, intraocular pressure, slit lamp examination, fundus examination by indirect ophthalmoscopy and ultrasound was done. Risk factors, Type of IOL, type of cataract surgery, complications and final visual outcomes were analyzed. All patients underwent 21 G pars plana vitrectomy and lens fragments were removed with phacofragmentome, vitrectomy cutter or delivered through limbus. RESULTS: 30 eyes of consecutive patients were studied. There were 20(66.66%) males and 10(33.33%) females. Associated risk factors found were 2(6.66%) PEX, 1(3.33%) subluxated lens. The BCVA after 11 months of PPV was found to be >6/12 in 20(66.6%) and <6/12 in 10(33.4%). Visual Rehabilitation was done with PCIOL in 22(73.33%), ACIOL in 4(13.33%), SFIOL in 4(13.33%). Poor visual outcome following PPV was attributed to RD in 2(6.7%), CME 1(3.3%), raised IOP 9(29.9%) [8(26.6% before and 1(3.3%) After PPV]. Rise of IOP was found in 8(26.60%) before PPV and 1(3.33%) after PPV.

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“…Immediate pars plana vitrectomy has advantages for the patient and for the eye. 33 Secondary glaucoma is an important complication of retained lens matter and this is prevented or reversed by early vitrectomy. 34 However, deferment of surgery for 2-3 weeks may allow lens material to become softer and easier to remove.…”

Section: Management: the Eyementioning

confidence: 99%

Vitreous loss during cataract surgery: prevention and optimal management

Jacobs

2008

Eye

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Vitreous loss during cataract surgery is associated with a poor visual outcome. Experienced surgeons and those performing a high volume of cataract operations have lower rates of vitreous loss. Risk stratification systems, which allow prediction of intraoperative complications from preoperative criteria exist, so that less experienced surgeons can avoid higher risk cases. The management of vitreous loss includes counselling patients before surgery of the potential risks and complications. When vitreous loss occurs, it is important for the surgeon to avoid actions which increase the chance of disaster for the eye. These include phacoemulsification in the presence of vitreous and attempts to recover dropped lens fragments from the posterior segment without vitrectomy. There are advantages in performing an anterior vitrectomy by the pars plana route rather than through the anterior chamber and this approach is facilitated by sutureless 23-gauge instruments. Dislocation of lens nuclear fragments into the vitreous is associated with a high incidence of retinal detachment as well as secondary glaucoma and cystoid macular oedema. Early involvement of a retinal surgeon in the management of these eyes is recommended.

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

Cited by 28 publications

References 26 publications

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

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

Analysis of Risk Factors, Visual Outcomes After Vitrectomy and Iol Implantation for Dropped Nucleus

Vitreous loss during cataract surgery: prevention and optimal management

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