Removal of Retained Lens Fragments after Phacoemulsification Reverses Secondary Glaucoma and Restores Visual Acuity

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.…”

“…Several studies, concluded that the timing of vitrectomy did not affect the visual outcome in respective large series of more than 100 eyes. 10,12,13,24 Another study of 89 eyes by Al-Khaier et al 14 reported that vitrectomy after 4 weeks statistically correlated with a poor visual outcome. Nonetheless, 44-69% of the patients achieving a final visual outcome of 6/12 or better.…”

“…10,[12][13][14]24 In most of the reported series, vitreous surgeries were not performed immediately or on the same day as the cataract surgery. 10,12,13 In the series by Al-Khaier et al, 14 they did not report the outcome of the 10 patients that received vitrectomy on the same day. Kim et al 8 reported that 75% of eight eyes operated on the same day as the cataract surgery had final vision of 6/9 or better, while only 63% of the other 54 eyes operated later had final vision of 6/12 or better.…”

“…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.…”