Abstract
Between March 1993 and September 1994 we treated 25 cases oflenses in the vitreous cavity. Nineteen of the 25 were the result of dislocation during phacoemulsification. During this time, we adopted a single surgical algorithm involving vitrectomy, heavy liquids and ultrasound fragmentation. The aims of this retrospective study were to test the validity of our surgical algorithm and to report on outcomes and complications. The indications for vitreous surgery were raised intraocular pressure, uveitis and poor vision. Vitreous surgery was carried out at a mean of 29 days following phacoemulsification. Six patients required heavy liquids and 5 needed ultrasound fragmentation. Vitreous surgery undertaken less than 17 days after phacoemulsification had an increased likelihood of requiring heavy liquids and/or fragmentation (p<0.02). The greatest threat to a favourable visual outcome was retinal detachment, which was significantly associated with fragmentation and use of heavy liquids (p<0.02). The presence of an intraocular lens (IOL) reduced the surgical options for removal of the lens fragments, and IOL should not be inserted where lens matter dislocates. The study suggests that we should avoid fragmentation and, provided the intraocular pressure and uveitis can be controlled, that vitreous surgery should be deferred for 2-3 weeks following phacoemulsification.
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References
Michels RG, Shacklett Col DE . Vitrectomy technique for the removal of retained lens material. Arch Ophthalmol 1977;95:1767–73.
Hutton WL, Snyder WB, Vaiser A . Management of surgically dislocated intravitreal lens fragments by pars plana vitrectomy. Trans Am Acad Ophthalmol Otolar-yngol 1978;85:176–89.
Fastenberg DM, Schwartz PL, Shakin JL, Golub BM . Management of dislocated nuclear fragments after phacoemulsification. Am J Ophthalmol 1991;112:535–9.
Peyman GA, Raichand M, Goldberg MF, Ritacca D . Management of subluxated and dislocated lenses with the vitrophage. Br J Ophthalmol 1979;63:771–8.
Blodi BA, Flynn HW Jr, Blodi CF, Folk JC, Daily MJ . Retained nuclei after cataract surgery. Ophthalmology 1992;99:41–4.
Haymet BT . Removal of a dislocated hypermature lens from the posterior vitreous. Aust NZ J Ophthalmol 1990;18:103–6.
Rowson NJ, Bacon AS, Rosen PH . Perfluorocarbon heavy liquids in the management of posterior dislocation of the lens nucleus during phacoemulsification. Br J Ophthalmol 1992;76:169–70.
Lewis H, Blumenkranz MS, Chang S . Treatment of dislocated crystalline lens and retinal detachment with perfluorocarbon liquids. Retina 1992;12:299–304.
Wallace RT, McNamara JA, Brown G, Benson W, Belmont J, Goldberg R, Federman J . The use of perfluorophenanthrene in the removal of intravitreal lens fragments. Am J Ophthalmol 1993;116:196–200.
Lambrou FH Jr, Stewart MW . Management of dislocated lens fragments during phacoemulsification. Ophthalmology 1992;99:1260–2; discussion 1269-9.
Seward HC, Dalton R, Davis A . Phacoemulsification during the learning curve: risk/benefit analysis. Eye 1993;7:164–8.
Korobelnik JF, Nabet L, Frau E, Elmaleh C, Hanna K, Pouliquen Y . Use of perfluorocarbon solutions in the surgical treatment of posterior luxation of the lens. J Fr Ophtalmol 1992;15:235–42.
Acheson JF, McHugh JD, Falcon MG . Changing patterns of early complications in cataract surgery with new techniques: a surgical audit. Br J Ophthalmol 1988;72:481–4.
Machemer R . The importance of fluid absorption, traction, intraocular currents, and chorioretinal scars in the therapy of rhegmatogenous retinal detachments. XLI Edward Jackson memorial lecture. Am J Ophthalmol 1984;98:681–93.
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Wong, D., Briggs, M., Hickey-Dwyer, M. et al. Removal of lens fragments from the vitreous cavity. Eye 11, 37–42 (1997). https://doi.org/10.1038/eye.1997.8
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DOI: https://doi.org/10.1038/eye.1997.8