Timing of vitrectomy for retained lens fragments after cataract surgery

Peck, Travis; Park, Janice; Bajwa, Asima; Shildkrot, Yevgeniy

doi:10.1007/s10792-017-0719-8

Cited by 14 publications

(6 citation statements)

References 35 publications

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“…One study comparing early (less than 7 days after cataract surgery) versus late (7 or more days after cataract surgery) vitrectomy for retained posterior segment lens fragments found similar clinical outcomes between the two groups. 16 Our patient deferred vitrectomy for removal of the lens fragment, and his intraocular inflammation resolved after aspiration of the material from the anterior chamber. In the context of retained lens fragments, corneal edema may result from a prolonged inflammatory reaction or mechanical damage to the endothelium and may require endothelial keratoplasty.…”

Section: Discussionmentioning

confidence: 73%

Retained lens fragment presenting 32 years after cataract extraction

Tien

Crespo

Milman

et al. 2022

American Journal of Ophthalmology Case Reports

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Section: Discussionmentioning

confidence: 73%

Retained lens fragment presenting 32 years after cataract extraction

Tien

Crespo

Milman

et al. 2022

American Journal of Ophthalmology Case Reports

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“…As against this, some authors have shown that the type of IOL used impacts the final visual outcomes. [ 13 , 16 , 17 ] Peck et al . [ 16 ] observed that anterior chamber IOL placement at the time of cataract extraction was linked to poorer ultimate visual acuity, when compared to sulcus placed IOLs or leaving the patient aphakic.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors and visual outcomes after immediate pars plana vitrectomy for posteriorly dislocated lens fragments during complicated phacoemulsification surgery

Kelkar

Mondal

et al. 2023

Indian Journal of Ophthalmology

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Purpose: To investigate the prognostic factors for visual outcome in patients undergoing immediate pars plana vitrectomy (PPV) for posteriorly dislocated lens fragments during phacoemulsification surgery. Methods: This was a single-center, retrospective, cross-sectional study of 37 eyes of 37 patients undergoing immediate PPV for posteriorly dislocated lens fragments from 2015 to 2021. The primary outcome measure was changes in the best-corrected visual acuity (BCVA). Additionally, we analyzed the predictive factors for poor visual outcomes (BCVA <20/40) and perioperative complications. Results: The mean (±standard deviation [SD]) age of the patients was 66.57 (±10.86) years, with an almost identical gender profile (M: F = 18/19 [48.64%:51.36%]). The median (interquartile range [IQR]) log of minimum angle of resolution (logMAR) BCVA improved significantly from the baseline (1 [0.6–1.48], ~20/200) to the final visit (0.3 [0.2–0.6], ~20/40) ( P < 0.0001) after a mean (±SD) follow-up of 6.35 (±6.32) months. The final BCVA was 20/40 or better in 59.5% of the eyes. Poor final BCVA (<20/40) was associated with small preoperative pupillary size ( P = 0.02), presence of preoperative ocular pathology ( P = 0.02) including uveitis, glaucoma, and clinically significant macular edema (CSME), intraoperative displacement of >50% of lens matter into the vitreous ( P < 0.001), use of iris-claw lens ( P < 0.001), and postoperative cystoid macular edema (CME; P = 0.007). The postoperative complications included CME (13.51%), retinal detachment (10.81%), chronic uveitis (8.11%), glaucoma (8.11%), iritis (2.7%), posterior chamber IOL (PCIOL) dislocation (2.7%), and vitreous hemorrhage (2.7%). Conclusion: For retained lens fragments in complicated phacoemulsification surgery, immediate PPV is a viable approach with the potential for a good visual outcome. The important predictors for poor visual outcomes include a small preoperative pupil size, preexisting ocular pathology, displacement of significant volume of lens matter (>50%), use of an iris-claw lens, and CME.

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“…Others have noted a trend toward higher rates of glaucoma in the early vitrectomy group, likely due to selection bias. Higher preoperative intraocular pressure leads to both early PPV and higher postoperative pressure [27]. A recent study showed lower incidence of postoperative ocular hypertension (17% compared to rates of 46--100% in the literature) and higher incidence of postoperative hypotony in patients undergoing PPV.…”

Section: Intraocular Pressurementioning

confidence: 94%

Indications for surgical management of retained lens fragments

Salabati

Mahmoudzadeh

Wakabayashi

et al. 2021

Current Opinion in Ophthalmology

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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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Timing of vitrectomy for retained lens fragments after cataract surgery

Cited by 14 publications

References 35 publications

Retained lens fragment presenting 32 years after cataract extraction

Retained lens fragment presenting 32 years after cataract extraction

Predictive factors and visual outcomes after immediate pars plana vitrectomy for posteriorly dislocated lens fragments during complicated phacoemulsification surgery

Indications for surgical management of retained lens fragments

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