Clinical Predictors and Outcomes of Pars Plana Vitrectomy for Retained Lens Material After Cataract Extraction

Ho, Lawrence Y.; Doft, Bernard H.; Wang, Li; Bunker, Clareann H.

doi:10.1016/j.ajo.2008.10.026

Cited by 66 publications

(50 citation statements)

References 42 publications

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“…3 In the present study, only 65% achieved 20/40 or better. The overall results may have been further compromised had patients with retinal detachment at presentation been included.…”

Section: Medical Versus Surgical Management Of Retained Lens Fragmentsmentioning

confidence: 66%

“…It is important to note that a significant number of patients in large series had retinal detachment on initial assessment or at the time of vitrectomy for retained lens fragments. 2,3 Finally, the present study may have included a number of patients with retained cortical material only, which may be less likely to require surgery. Although many patients with retained lens material after cataract surgery do not require urgent vitrectomy, we believe that early referral for a vitreoretinal opinion is critical.…”

Section: Medical Versus Surgical Management Of Retained Lens Fragmentsmentioning

confidence: 97%

See 1 more Smart Citation

Medical versus surgical management of retained lens fragments

Merani

Hunyor

2009

Journal of Cataract and Refractive Surgery

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“…3 In the present study, only 65% achieved 20/40 or better. The overall results may have been further compromised had patients with retinal detachment at presentation been included.…”

Section: Medical Versus Surgical Management Of Retained Lens Fragmentsmentioning

confidence: 66%

Section: Medical Versus Surgical Management Of Retained Lens Fragmentsmentioning

confidence: 97%

Medical versus surgical management of retained lens fragments

Merani

Hunyor

2009

Journal of Cataract and Refractive Surgery

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“…Recent reports indicate that light scattering on the surface of the AcrySof intraocular lens (IOL) optic (Alcon Laboratories, Inc.) increases over time postoperatively. [1][2][3] This scattering as "whitening" was first reported in 2002 by Yaguchi et al 4 We have suggested that the main cause of this phenomenon is phase separation of trace amounts of water impregnated in the IOL optic material as well as glistening. 5 When we observe glistening under a light microscope, the water phase has a bright-spot-like appearance and the phase diameter is 5 to 20 mm.…”

Section: Discussionmentioning

confidence: 95%

“…Several studies have looked at the outcomes of pars plana vitrectomy for retained lens material. 1 However, few or no studies have examined the outcome of phacoemulsification cataract extraction converted to ECCE. We performed a retrospective case-note review to evaluate indications for and visual results of phacoemulsification cataract extractions converted to ECCE at our hospital.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative conversion from phacoemulsification to manual extracapsular cataract extraction

Mercieca¹,

Brahma²,

Patton³

et al. 2011

Journal of Cataract and Refractive Surgery

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Multiple 10-0 nylon sutures may be required to close the main wound and the side port. Seidel testing of the wounds and segment junctions is performed and additional sutures added to ensure a watertight seal. CASE REPORTThe importance of wound placement is demonstrated in a patient who had cataract surgery 4 years after keratolimbal allograft and tube-shunt surgery. Based on the tube location and efforts to avoid an inferiorly placed wound, the main wound was made adjacent to a keratolimbal allograft junction. After the IOL was inserted, the edge of 1 segment became elevated. Four 10-0 nylon sutures were required to reappose the 2 segments to prevent leakage at the junction, and 3 sutures were required at the main wound to ensure Seidel negative testing ( Figure 3). DISCUSSIONA customized approach is necessary when performing cataract surgery in eyes with prior surgeries, especially in complex cases of congenital aniridia or congenital aniridia variant after keratolimbal allograft. Improved surgical outcomes and optimization of visual potential is achieved by careful recognition of the considerations we have highlighted: use of visualization enhancement measures (capsular staining and iris hooks), careful wound placement, appreciation of anterior capsule fragility, and diligent wound closure to prevent hypotony. REFERENCES 1. Nelson LB, Spaeth GL, Nowinski TS, Margo CE, Jackson L. Aniridia. A review. Surv Ophthalmol 1984; 28:621-642 2. Skeens HM, Brooks BP, Holland EJ. Congenital aniridia variant: minimally abnormal irides with severe limbal stem cell deficiency. In press, Ophthalmology 2011 3. Holland EJ, Djalilian AR, Schwartz GS. Management of aniridic keratopathy with keratolimbal allograft: a limbal stem cell transplantation technique. Ophthalmology 2003; 110:125-130 4. Neuhann IM, Neuhann TF. Cataract surgery and aniridia. Curr Opin Ophthalmol 2010; 21:60-64 5. Schneider S, Osher RH, Burk SE, Lutz TB, Montione R. Thinning of the anterior capsule associated with congenital aniridia.Despite the high success rate of phacoemulsification cataract extraction, there are times when continuing the planned operation is no longer desirable. The cataract surgeon must then choose between converting to manual extracapsular cataract extraction (ECCE) or referring the patient for cataract extraction through a pars plana approach. Several studies have looked at the outcomes of pars plana vitrectomy for retained lens material. 1 However, few or no studies have examined the outcome of phacoemulsification cataract extraction converted to ECCE. We performed a retrospective case-note review to evaluate indications for and visual results of phacoemulsification cataract extractions converted to ECCE at our hospital. PATIENTS AND METHODSPatients were identified from electronic operative records from 2005 through 2009. All operations were performed or supervised by surgeons who had trained when ECCE was performed routinely.

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“…However, the use of small-gauge instrumentation limits conjunctival scarring, which may be an important consideration, because eyes after complicated cataract surgery with retained lens fragments may be at increased risk for glaucoma. 18 One advantage when using small-gauge instrumentation for retained lens fragments is the ability to insert the vitreous cutter tip into the anterior chamber through a small self-sealing paracentesis. This enables the surgeon to remove residual cortical material in the anterior chamber and remove prolapsed or incarcerated vitreous.…”

Section: Discussionmentioning

confidence: 99%