Retinal Tears and Retinal Detachment as Factors Affecting Visual Outcome After Cataract Extraction Complicated by Posteriorly Dislocated Lens Material

Abstract

A good visual outcome (20/40 or better) is possible in eyes with posteriorly dislocated lens fragments after cataract extraction, even when retinal tears or macula-on retinal detachment is present. The presence of a macula-off retinal detachment, however, has a significant adverse effect on the visual outcome. Pneumatic retinopexy is not associated with retinal reattachment in many cases and is not preferred.

V.B.7. Pneumatic Retinopexy

“…Eyes treated with PR for RRD post PPV to remove posteriorly dislocated lens material require secondary SB to achieve reattachment in 63 % of cases [ 51 ]. Macular pucker develops in 3 % [ 85 ].…”

“…Lastly, some studies show that being male correlates with primary PR failure [ 48 , 50 ], perhaps due to lack of patient compliance. PR usually fails in RRD following vitrectomy for posteriorly dislocated lens fragments and requires subsequent scleral buckling [ 51 ]. PR has also been reported to cause anterior displacement of Artisan intraocular lenses [ 52 ].…”

Retinal Breaks in Vitrectomy for Retained Lens Fragments

“…Two studies mentioned an incidence of retinal breaks of 4% to 5%. 10,17 In one of these studies, however, the search for breaks was performed after vitrectomy using indirect ophthalmoscopy. 10 In the second study, retinal breaks were detected pre-, intra-, and postoperatively and intraoperative search technique was not specified.…”

Functional and anatomical outcomes of vitreoretinal surgery for posterior segment complications after elective cataract surgery

“…More than 1 surgical intervention may be required in more complex situations, such as bacterial endophthalmitis, early postoperative RD, or choroidal hemorrhage. [13][14][15][16][17][18][19][20][21][22] Following retention of lens fragments and associated problems, RD is the most common complication of cataract surgery. In the present study, approximately 85% of patients with RD had prolapse of the vitreous that was not treated during cataract surgery.…”

“…[23][24][25][26] If the stability of the retina is not compromised by capsule rupture with consequent vitreoretinal traction or nuclear fragment retention, favorable outcomes can be expected. 19,23,27 The risk for RD after complicated cataract surgery can be lowered by adopting simple prophylactic strategies. Most important, a complete anterior vitrectomy should be performed via the pars plana route.…”