Retained intravitreal lens fragments after phacoemulsification: Complications and visual outcome in vitrectomized and nonvitrectomized eyes

Abstract

Intraocular inflammation, increased IOP, and CME were major complications in nonvitrectomized eyes after phacoemulsification; retinal detachment occurred in 2 vitrectomized eyes. In eyes with intravitreal lens fragments after phacoemulsification, vitrectomy can yield faster visual rehabilitation and better quality of vision. Conservative management is feasible at the price of long-term intraocular inflammation and slower restoration of comparable visual function.

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 is an important finding since secondary glaucoma had been reported in 5-41% in previous studies in which pars plana vitrectomy was performed later. 6,8,10,[13][14][15]20,21,24 Blodi et al 9 also showed that early pars plana vitrectomy within 3 weeks decreased the rate of chronic glaucoma. Wilkinson and Green 22 have shown that in 135 consecutive vitreous specimens that were obtained during vitreous surgery for retained lens material after surgery for senile cataract, no inflammatory cells were found in which vitrectomy was performed within 3 days of cataract surgery while lensinduced inflammatory reaction increased as the time interval of surgeries increased.…”

“…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.…”

“…8,[13][14][15] Margherio et al 13 found that 27% of patients developed postoperative cystoid macular oedema after vitrectomy as a late postoperative complication. When vitrectomy was performed on the same setting of cataract surgery, Kageyama et al 5 reported a lower rate of postoperative cystoid macular oedema of 12%.…”

“…[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.…”