Tackling the "dropped nucleus"

Abstract

ABSTRACT.Purpose: To summarize and analyse the results of our experience in treating patients with a ''dropped nucleus''. Methods: The case records of nineteen patients who underwent surgery for a ''dropped nucleus'' at the Ophthalmology Departments of Sahlgren's University Hospital, Gothenburg, and Ö rebro Medical Centre, Ö rebro, Sweden during 1994 were retrospectively reviewed to determine the mode of treatment used and the results of surgery. The frequency of this complication was also calculated for Sweden as a whole with the help of the National Cataract Register. Results: The lens was successfully removed in all eyes. No retinal breaks or detachments were present at vitrectomy or follow-up. One eye was lost to panophthalmitis 11 days after the vitrectomy; the remaining 18 eyes showed a favourable outcome. Conclusion: The loss of a crystalline lens to the vitreous during cataract surgery is a severe complication. We recommend that an experienced vitreoretinal surgeon should be consulted at an early stage.

A retrospective study of patients with retained nuclear fragments after cataract extraction

“…In our study a statistically significant number of retinal detachments was found in those eyes manipulated by the cataract surgeon (pΩ0.01). This supports the view that the cataract surgeon should not try to retrieve the dislocated lens fragments from the vitreous cavity (Kim et al 1994;Margherio et al 1997;Kapusta et al 1996;Aaberg et al 1997;Stenkula et al 1998).…”

Artisan lens implantation to correct aphakia after vitrectomy for retained nuclear lens fragments

“…23 With an incidence of RD between 3% and 18% after removal of a dropped nucleus, careful examination of the peripheral retina is advisable, particularly in the first 2 to 3 months. [24][25][26][27][28][29][30][31][32] The older iris-plane lenses severely limited pupil dilation. [33][34][35][36][37] This limitation does not occur with Artisan lenses, allowing good visualization of the peripheral retina.…”

Meta-analysis comparing same-day versus delayedvitrectomy clinical outcomes for intravitreal retained lens fragments after age-relatedcataract surgery

“…The analysis estimating each study’s power for comparing outcomes was updated, and the results (mean =24%, median =14%) again indicated that many studies had low power. Figure 2A shows whether SD-PPV or DEL-PPV seemed better for each outcome, for all articles with these data 2,3,6,7,11,12,14,15,17–19,22,24–27,29–31,34,35,40,43–45. These SD-PPV vs DEL-PPV results appear mixed and do not obviously favor either vitrectomy time.…”

“…However, the logistics of arranging an SD-PPV can be daunting 16,17. Others feel that SD-PPV is unnecessary, complicates the informed consent process, and may increase the risk of complications 18,19. A survey of cataract surgeons indicated they believed that 58% of patients had retained lens fragments removed immediately,20 far higher than reported by vitreoretinal surgeons, who indicated only 13% (536 of 4,150) of eyes received an SD-PPV 21…”