Abstract:To analyze outcomes and complications related to cataract surgery complicated by retained lens fragment (RLF) requiring pars plana vitrectomy (PPV) in a county hospital where procedures are performed by trainees. Methods: Retrospective study of consecutive patients who met inclusion criteria and underwent PPV for RLF in the vitreous cavity at an urban teaching hospital between January 2010 and January 2016 (N=20). Main Outcomes/Measures: Visual acuity was recorded pre-and post-operatively over a follow-up peri… Show more
“…Retained lens fragments is an uncommon complication of cataract surgery, causing varying degrees of intraocular inflammation due to the immunogenic nature of lens material. 2 , 21 Removal of RLF via PPV reduces long-term sequalae and improves visual acuity by decreasing inflammation. 6 , 9 , 21 …”
Section: Discussionmentioning
confidence: 99%
“…Retained lens fragments (RLF), one of the most frequent complications of cataract surgery, occurs in 0.1 to 1.5% of cases ( Figure 1 ). 1 , 2 Secondary complications of RLF include glaucoma, cystoid macular edema, vitreous hemorrhage, uveitis, and retinal detachment (RD). 3–7 Figure 1 Fundus photo demonstrating posteriorly dislocated retained lens fragments after cataract surgery.…”
Purpose
To evaluate the outcomes and complications in patients with retained lens fragments (RLF) after cataract surgery, comparing those who received pars plana vitrectomy (PPV) on the same day, within 1 week, or later than 1 week after cataract surgery.
Patients and Methods
Retrospective case series of all patients who underwent PPV for RLF at Bascom Palmer Eye Institute between January 1, 2012 and September 30, 2020. Individuals with less than 3 months of follow-up, chronic uveitis, congenital cataract, previtrectomy retinal detachment (RD), and severe trauma were excluded. All analyses for categorical and binary variables used chi-squared tests. Analyses for continuous variables were performed using multivariate analyses of covariance, adjusting for differences in baseline visual acuity before cataract surgery.
Results
The study included 246 eyes of 246 patients. The timing distribution included the following: 140 (57%) eyes underwent same-day PPV, 33 (13%) eyes underwent same-week PPV, and 73 (30%) eyes underwent PPV after 1 week (up to 90 days). When all eyes were included in analysis, there were no statistically significant differences in mean best-corrected visual acuity (BCVA) between groups at last follow-up examination (
P
= 0.07). When only eyes without known pre-existing ocular disease (N = 157) were included in analysis, there were no differences in mean BCVA between groups at all postoperative timepoints (
P
> 0.05). The rate of RD did not differ between groups when eyes with and without pre-existing ocular disease were analyzed (
P
> 0.05).
Conclusion
In the current study, there were no statistically significant differences in postoperative BCVA or rates of RD at last follow-up examination in eyes undergoing PPV for RLF on the same day, within 1 week, or later than 1 week after cataract surgery.
“…Retained lens fragments is an uncommon complication of cataract surgery, causing varying degrees of intraocular inflammation due to the immunogenic nature of lens material. 2 , 21 Removal of RLF via PPV reduces long-term sequalae and improves visual acuity by decreasing inflammation. 6 , 9 , 21 …”
Section: Discussionmentioning
confidence: 99%
“…Retained lens fragments (RLF), one of the most frequent complications of cataract surgery, occurs in 0.1 to 1.5% of cases ( Figure 1 ). 1 , 2 Secondary complications of RLF include glaucoma, cystoid macular edema, vitreous hemorrhage, uveitis, and retinal detachment (RD). 3–7 Figure 1 Fundus photo demonstrating posteriorly dislocated retained lens fragments after cataract surgery.…”
Purpose
To evaluate the outcomes and complications in patients with retained lens fragments (RLF) after cataract surgery, comparing those who received pars plana vitrectomy (PPV) on the same day, within 1 week, or later than 1 week after cataract surgery.
Patients and Methods
Retrospective case series of all patients who underwent PPV for RLF at Bascom Palmer Eye Institute between January 1, 2012 and September 30, 2020. Individuals with less than 3 months of follow-up, chronic uveitis, congenital cataract, previtrectomy retinal detachment (RD), and severe trauma were excluded. All analyses for categorical and binary variables used chi-squared tests. Analyses for continuous variables were performed using multivariate analyses of covariance, adjusting for differences in baseline visual acuity before cataract surgery.
Results
The study included 246 eyes of 246 patients. The timing distribution included the following: 140 (57%) eyes underwent same-day PPV, 33 (13%) eyes underwent same-week PPV, and 73 (30%) eyes underwent PPV after 1 week (up to 90 days). When all eyes were included in analysis, there were no statistically significant differences in mean best-corrected visual acuity (BCVA) between groups at last follow-up examination (
P
= 0.07). When only eyes without known pre-existing ocular disease (N = 157) were included in analysis, there were no differences in mean BCVA between groups at all postoperative timepoints (
P
> 0.05). The rate of RD did not differ between groups when eyes with and without pre-existing ocular disease were analyzed (
P
> 0.05).
Conclusion
In the current study, there were no statistically significant differences in postoperative BCVA or rates of RD at last follow-up examination in eyes undergoing PPV for RLF on the same day, within 1 week, or later than 1 week after cataract surgery.
“…The timing between complicated cataract surgery and PPV in cases with RLF has long been a topic of debate. [ 15 ] A systematic review and meta-analysis reported that early PPV for eyes with RLF yielded better visual outcomes and reduced the risk of secondary complications such as retinal detachment, high IOP, endophthalmitis, and intraocular inflammation. [ 36 ] Our institute is a specialized tertiary center with many vitreoretinal surgeons available in case of complications.…”
Section: Discussionmentioning
confidence: 99%
“…Although RLF is considered an uncommon complication, it can lead to secondary complications such as glaucoma, prolonged inflammation, cystoid macular edema (CME), retinal detachment, and corneal decompensation. [ 15 16 17 18 19 20 21 ]…”
PURPOSE:
To study the risk factors, visual outcomes, and sequelae of phacoemulsification surgery complicated by retained lens fragments (RLFs).
METHODS:
This single-center case–control study enrolled consecutive eyes complicated by RLF and compared them to age- and gender-matched uneventful cataract surgery cases at a tertiary care teaching hospital. Biometric, intraoperative, and postoperative data were collected. The primary outcome measures were risk factors, visual outcomes, and rate of postoperative complications.
RESULTS:
The study and control groups included 282 and 289 eyes, respectively. The estimated incidence of RLF was 1.47% during the study. We found a statistically higher risk of RLF among diabetics (P < 0.001), those with a history of intravitreal injections (P = 0.001), eyes with dense nuclear sclerosis, anterior capsular cataract (P < 0.001), and posterior polar cataract (P = 0.01). There was a statistically higher risk of RLF in eyes with a higher mean preoperative visual acuity (logarithm of the minimum angle of resolution) (P < 0.001) and in cases performed by trainees (P < 0.001). Most eyes in the RLF group (n = 207, 73.4%) retained their preoperative vision or experienced a one-line improvement in visual acuity and 14 eyes (5.3%) experienced more than one-line improvement in vision.
CONCLUSION:
Although RLFs are rare, they can affect the quality of postoperative vision and outcomes of complicated phacoemulsification surgery.
“…Although currently there is no definite guideline for the timing of surgery for retained lens fragments, more urgent surgery should be considered in patients that are refractory to medical treatments, including those who have dangerously elevated intraocular pressures or marked uveitis despite observation or medical therapy. Surgical intervention is also warranted in the presence of large fragments of the lens material, as these fragments are associated with decreased visual acuity, corneal edema, retinal tears and detachments, and endophthalmitis [11].…”
Section: Surgical Management Of Retained Lens Fragmentsmentioning
Purpose of reviewRetained lens fragments are a relatively rare occurrence after cataract surgery. While no definite guidelines for the surgical management or timing of surgery of this complication exist, surgery is indicated for patients with large lens fragments, persistent inflammation, secondary glaucoma, corneal edema, retinal tears or detachments, and associated endophthalmitis. The aim of this review is to summarize the current surgical management of retained lens material.
Recent findingsThe Intelligent Research in Sight registry database of 2.26 million patients who underwent cataract surgery in the US indicated that 0.18% (1 in 563) had secondary removal of retained lens fragments in the anterior chamber in the operating room within 1 year of the original cataract surgery. The risk of returning to the operating room for retained lens material removal was greater among men, smokers, patients with Medicaid or military insurance, and those who had complex cataract surgery. Medical management with topical corticosteroids or observation may be considered for small lens fragments, but surgical removal remains the mainstay of the treatment for large lens fragments.
SummaryRetained lens fragments following cataract surgery may result in various vision-threatening complications. Understanding the risk factors, diagnosis, and surgical management of retained lens fragments are critical to preserving good visual outcomes. Vitrectomy is effective in patients with posterior nuclear fragments, retinal detachment, endophthalmitis, or uncontrolled glaucoma not responding to medical management. The best timing for surgery for retained lens fragments should be further investigated in a prospective study.
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