Contemporary Outcomes and Prognostic Factors of 23-Gauge Vitrectomy for Retained Lens Fragments After Phacoemulsification

Chan, Errol W.; Yang, Elizabeth; Eldeeb, Mohab; Bainbridge, James; Cruz, Lyndon da; Sullivan, Paul; Muqit, Mahiul M. K.; Charteris, David G.; Minihan, M.; Ezra, Eric; Wickham, Louisa

doi:10.1016/j.ajo.2020.05.028

Cited by 5 publications

(9 citation statements)

References 43 publications

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“…Timing of the IOL implantation (during primary phacoemulsification or during/after vitrectomy) and the type of IOL did not significantly impact final vision. This study showed that the results of the 23-gauge vitrectomy for retained lens fragments are similar to those of non-MIVS studies [10].…”

Section: Outcomes Of Vitrectomysupporting

confidence: 77%

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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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Section: Outcomes Of Vitrectomysupporting

confidence: 77%

“…In the cases where the lens fragment is in the posterior segment, pars plana vitrectomy (PPV) remains the most effective strategy to remove the intravitreal material [10]. Prior to surgical treatment, concomitant issues of inflammation and increased intraocular pressure should be managed medically.…”

Section: Surgical Management Of Retained Lens Fragmentsmentioning

confidence: 99%

Indications for surgical management of retained lens fragments

Salabati

Mahmoudzadeh

Wakabayashi

et al. 2021

Current Opinion in Ophthalmology

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“…9 Paul et al and Chan et al reported more favorable outcomes in eyes with DLF, with 82.5% and 62.9% of the eyes achieving a Snellen VA of ≥20/40 at 3 and 6 months of followup, respectively. 16,17 It is of note that direct comparison of visual outcomes between studies is difficult because of variability in inclusion criteria, follow-up duration, and the nature of reporting.…”

Section: Discussionmentioning

confidence: 99%

“…8,15 The visual outcome and reported complication rates after managing eyes with DLF vary among reports. 9,11,[15][16][17] This can be attributed to the small sample sizes, the lack of distinction between PCR alone and PCR with DLF, and the variability of follow-up intervals used by different investigators.…”

mentioning

confidence: 99%

Visual outcomes and postoperative complications of eyes with dropped lens fragments during cataract surgery: multicenter database study

Foaud

Jabbehdari

Neuhouser

et al. 2023

J Cataract Refract Surg

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“…[ 3 , 4 ] A small minority of these eyes can be managed medically, but a pars plana vitrectomy (PPV) is still the gold standard for removing residual lens debris and reducing the risk of further complications. [ 4 , 5 ] As a result, the roles of both the cataract surgeon and the vitreoretinal (VR) surgeon are critical in the prevention and management of displaced lens fragments in the vitreous cavity.…”

mentioning

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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Contemporary Outcomes and Prognostic Factors of 23-Gauge Vitrectomy for Retained Lens Fragments After Phacoemulsification

Cited by 5 publications

References 43 publications

Indications for surgical management of retained lens fragments

Indications for surgical management of retained lens fragments

Visual outcomes and postoperative complications of eyes with dropped lens fragments during cataract surgery: multicenter database study

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

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