Visual outcome of early and late pars plana vitrectomy in patients with dropped nucleus during phacoemulsification

Abstract

Background: Dislocated lens fragments in the vitreous cavity can cause potentially serious complications. This retrospective study aimed to evaluate the visual outcome of patients who underwent pars plana vitrectomy (PPV) for posteriorly dislocated lens fragments after cataract phacoemulsification.

Methods: A retrospective study was conducted on all consecutive cases (60 patients) with pars plana vitrectomy performed for retained lens fragment. In 30 eyes (50%), PPV was performed within 1 week of cataract extraction and in 30 eyes (50 %), PPV was performed more than 1 week post cataract extraction from July 2005 through August 2008.

Results: In the late vitrectomy group, 66.6% of eyes developed persistent uveitis, 53.3% of eyes showed elevated intra-ocular pressure (IOP) and 5 eyes retinal detachment. In early PPV group 16.6% developed uveitis and 20% showed elevated IOP and one eye retinal detachment. The final visual acuity was 20 ± 50 in early PPV and 20 ± 200 in late PPV group (mean ± SD, p < 0.001).

Conclusions: The early use of PPV to remove posterior dislocated lens fragments within the first week was shown to be advantageous. The inflammatory response was less pronounced, IOP rose less significant, the incidence of retinal detachment was lower and visual recovery was faster.

Keywords: Nucleus Loss; Pars Plana Vitrectomy; Phacoemulsification; Retained Lens Fragment.

Figure 1

Clinical features of patients with retained lens fragments in initial examination AC: Anterior Chamber, IOP: Intra Ocular Pressure, RD: Retinal Detachment, CME: Cystoid Macular Edema